Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 27554 | IA |
NPI | 1013991082 |
---|---|
Provider Name | Chirantan Ghosh |
First Address | Cedar Rapids, IA 52402-2460 |
Second Address | Cedar Rapids, IA 52402-2460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 25/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1066704 | (05) | IA |
48937 | BLUE CROSS BLUE SHIELD (01) | IA |
E54250 | (02) | IA |