1831456318 NPI number — BITAN GHOSH M.D

Table of content: BITAN GHOSH M.D (NPI 1831456318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831456318 NPI number — BITAN GHOSH M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHOSH
Provider First Name:
BITAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831456318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601643
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-1643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-302-9300
Provider Business Mailing Address Fax Number:
704-302-9301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10745 WESTSIDE WAY STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30009-7635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-410-4610
Provider Business Practice Location Address Fax Number:
888-990-1674
Provider Enumeration Date:
04/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2016-00204 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 078626 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NC2809 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831456318 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".