MEDICARE: GHOSH PSYCHIATRIC SERVICES, LLC

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	225XM0800X	Mental Health Occupational Therapist	127287	AK

General Provider Information

NPI Number	:	1952626863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GHOSH PSYCHIATRIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	9138 ARLON ST
Second Line	:	B6
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-3876
Country	:	US
Telephone Number	:	907-317-2053
Fax Number	:	907-644-8099

Provider Business Practice Location Address
First Line	:	9138 ARLON ST
Second Line	:	STE B6
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-3876
Country	:	US
Telephone Number	:	907-301-0943
Fax Number	:	907-644-8099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHUBHRANJAN GHOSH
Credential	:	M.D.
Telephone Number	:	907-301-0943

Provider Enumeration Date	:	04/02/2010
Last Update Date	:	07/14/2010

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