Provider Demographics
NPI:1033115241
Name:GOSAI, KAMLESH B (MD)
Entity Type:Individual
Prefix:
First Name:KAMLESH
Middle Name:B
Last Name:GOSAI
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 1:119 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-1027
Mailing Address - Country:US
Mailing Address - Phone:724-239-4700
Mailing Address - Fax:724-489-0350
Practice Address - Street 1:119 WILSON RD
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1027
Practice Address - Country:US
Practice Address - Phone:724-239-4700
Practice Address - Fax:724-489-0350
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD40975E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011218240002Medicaid
PA0011218240002Medicaid
B34412Medicare UPIN