Healthcare Provider Details

I. General information

NPI: 1043326382
Provider Name (Legal Business Name): HITENDRA B GHOSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 S 84TH ST ANESTHESIA DEPT
PAPILLION NE
68131
US

IV. Provider business mailing address

PO BOX 31733
OMAHA NE
68131
US

V. Phone/Fax

Practice location:
  • Phone: 402-593-3830
  • Fax:
Mailing address:
  • Phone: 314-453-0600
  • Fax: 314-453-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15537
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number15537
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: