Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2018019979 | MO |
Y | 111NI0900X | Internist | 2018019979 | MO |
NPI | 1003310822 |
---|---|
Provider Name | Soumojit Ghosh |
First Address | Saint Louis, MO 63104-1004 |
Second Address | Saint Louis, MO 63110-2540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 27/10/2021 |