Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | BP10057230 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | S6846 | TX |
NPI | 1255780276 |
---|---|
Provider Name | Aditi Ghosh |
First Address | Galveston, TX 77555-0570 |
Second Address | Galveston, TX 77555-0570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2016 |
Last Update Date | 19/06/2020 |