Provider Demographics
NPI:1285604744
Name:GHOSH, SUMIT (MD)
Entity type:Individual
Prefix:
First Name:SUMIT
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:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0934
Mailing Address - Country:US
Mailing Address - Phone:570-714-5525
Mailing Address - Fax:570-714-5548
Practice Address - Street 1:790 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-8799
Practice Address - Country:US
Practice Address - Phone:570-586-5155
Practice Address - Fax:570-586-5105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068092L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028744Medicare ID - Type Unspecified
PAG98090Medicare UPIN