Provider Demographics
NPI:1891581310
Name:GOSWAMI, AVISHEK (MD)
Entity type:Individual
Prefix:DR
First Name:AVISHEK
Middle Name:
Last Name:GOSWAMI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SANDRA MURAIDA WAY UNIT 15H
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5091
Mailing Address - Country:US
Mailing Address - Phone:408-883-0268
Mailing Address - Fax:
Practice Address - Street 1:7201 W GRANDRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6709
Practice Address - Country:US
Practice Address - Phone:509-221-5520
Practice Address - Fax:509-221-5520
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMDRE.ML.61684514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine