=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477720639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANJAN GHOSH MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2008
-----------------------------------------------------
Last Update Date | 05/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 456 W 51ST PL
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-819-7770
-----------------------------------------------------
Fax | 305-819-8898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15710 NW 10TH ST
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33028-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-819-7770
-----------------------------------------------------
Fax | 305-819-8898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANJAN KUMAR GHOSH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-819-7770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------