Healthcare Provider Details

I. General information

NPI: 1700087145
Provider Name (Legal Business Name): ASISH GHOSHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 COYLE AVE
CARMICHAEL CA
95608-6311
US

IV. Provider business mailing address

6601 COYLE AVE
CARMICHAEL CA
95608-6311
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-1288
  • Fax: 916-967-0518
Mailing address:
  • Phone: 916-967-1288
  • Fax: 916-967-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA42055
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberA42055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: