Provider Demographics
NPI:1013204049
Name:GHOSH CENTER FOR ONCOLOGY AND HEMATOLOGY LLC
Entity Type:Organization
Organization Name:GHOSH CENTER FOR ONCOLOGY AND HEMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIRANTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-294-1899
Mailing Address - Street 1:1951 51ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2460
Mailing Address - Country:US
Mailing Address - Phone:319-294-1899
Mailing Address - Fax:319-294-1773
Practice Address - Street 1:1951 51ST ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2460
Practice Address - Country:US
Practice Address - Phone:319-294-1899
Practice Address - Fax:319-294-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6590320001Medicare NSC