Provider Demographics
NPI:1194774182
Name:GHOSH, BIJOY (MD)
Entity type:Individual
Prefix:
First Name:BIJOY
Middle Name:
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 1:100 DERBY DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21912-1037
Mailing Address - Country:US
Mailing Address - Phone:410-275-1704
Mailing Address - Fax:410-275-1703
Practice Address - Street 1:111 W HIGH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5529
Practice Address - Country:US
Practice Address - Phone:410-620-4722
Practice Address - Fax:410-620-4952
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD16241207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02350B02Medicare PIN
MD283PMedicare PIN