Provider Demographics
NPI:1316129505
Name:NIMISH GOSRANI MD PLLC
Entity type:Organization
Organization Name:NIMISH GOSRANI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-691-9960
Mailing Address - Street 1:PO BOX 9829
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27429-0829
Mailing Address - Country:US
Mailing Address - Phone:336-691-9960
Mailing Address - Fax:
Practice Address - Street 1:104 W NORTHWOOD ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1326
Practice Address - Country:US
Practice Address - Phone:336-691-9960
Practice Address - Fax:336-665-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700567207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2336198Medicare PIN