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General NPI Number Information
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NPI Number | 1891581310
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Entity Type | Individual
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Provider Name | AVISHEK GOSWAMI MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 7201 W GRANDRIDGE BLVD
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City | KENNEWICK
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State | WA
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Zip | 99336-6709
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Country | US
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Telephone | 509-221-5520
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Fax | 509-221-5520
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Provider Business Mailing Address
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Address Line | 111 SANDRA MURAIDA WAY UNIT 15H
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City | AUSTIN
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State | TX
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Zip | 78703-5091
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Country | US
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Telephone | 408-883-0268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MDRE.ML.61684514
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License Number State | WA
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