MEDICARE: DR. SUBIR 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	38152	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487657268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUBIR GHOSH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 907
Second Line	:
City	:	JACKSON
State	:	KY
Zip	:	41339-0907
Country	:	US
Telephone Number	:	606-666-5142
Fax Number	:	606-666-4172

Provider Business Practice Location Address
First Line	:	832 HWY 15 NORTH
Second Line	:
City	:	JACKSON
State	:	KY
Zip	:	41339-8601
Country	:	US
Telephone Number	:	606-666-5142
Fax Number	:	606-666-4172

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/19/2009

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