MEDICARE: DR. ANJAN K GHOSH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	ME77629	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QC118	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1124089354	OTHER	FL	NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124089354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANJAN K GHOSH M.D.

Provider Business Mailing Address
First Line	:	8146 CEREBELLUM WAY STE 102
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-1786
Country	:	US
Telephone Number	:	727-264-8865
Fax Number	:	855-801-6125

Provider Business Practice Location Address
First Line	:	8146 CEREBELLUM WAY STE 102
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-1786
Country	:	US
Telephone Number	:	727-264-8865
Fax Number	:	855-801-6125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	02/23/2023

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