Provider Demographics
NPI:1124089354
Name:GHOSH, ANJAN K (MD)
Entity type:Individual
Prefix:DR
First Name:ANJAN
Middle Name:K
Last Name:GHOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 CEREBELLUM WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1786
Mailing Address - Country:US
Mailing Address - Phone:727-264-8865
Mailing Address - Fax:855-801-6125
Practice Address - Street 1:8146 CEREBELLUM WAY STE 102
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1786
Practice Address - Country:US
Practice Address - Phone:727-264-8865
Practice Address - Fax:855-801-6125
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77629208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQC118OtherMEDICARE
FL1124089354OtherNPI
FLE3152UMedicare ID - Type Unspecified
FLE35433Medicare UPIN