MEDICARE: SUSHANTA K. GOSWAMI 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	207RN0300X	Nephrology Physician	MD27500	OK
2	207R00000X	Internal Medicine Physician	MD00038023	WA
3	208M00000X	Hospitalist Physician	R3091	TX
4	207R00000X	Internal Medicine Physician	R3091	TX
5	207RN0300X	Nephrology Physician	R30091	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0170996	OTHER	WA	L & I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8902519	OTHER	WA	CRIME VICTIMS
4	P00049522	OTHER	WA	RAILROAD

General Provider Information

NPI Number	:	1366548547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSHANTA K. GOSWAMI M.D.

Provider Business Mailing Address
First Line	:	5002 COWHORN CREEK RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-9766
Country	:	US
Telephone Number	:	903-614-3000
Fax Number	:	903-614-3525

Provider Business Practice Location Address
First Line	:	85 IH 10 N STE 112
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77707-2560
Country	:	US
Telephone Number	:	409-239-5139
Fax Number	:	409-730-8055

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	03/03/2026

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