Provider Demographics
NPI:1316286982
Name:AMITABH U. GOSWAMI, DO, INC.
Entity type:Organization
Organization Name:AMITABH U. GOSWAMI, DO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMITABH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:559-286-5664
Mailing Address - Street 1:7255 N CEDAR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3831
Mailing Address - Country:US
Mailing Address - Phone:559-478-4757
Mailing Address - Fax:559-323-4143
Practice Address - Street 1:7255 N CEDAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3831
Practice Address - Country:US
Practice Address - Phone:559-478-4757
Practice Address - Fax:559-323-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-02
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9044208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A90440Medicare PIN