Healthcare Provider Details

I. General information

NPI: 1124759998
Provider Name (Legal Business Name): BINITA GHOSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL DR
UKIAH CA
95482-4531
US

IV. Provider business mailing address

275 HOSPITAL DR
UKIAH CA
95482-4531
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-3111
  • Fax: 707-463-7384
Mailing address:
  • Phone: 707-462-3111
  • Fax: 707-463-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA199858
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA199858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: