Provider Demographics
NPI:1356446595
Name:GHOSH, DEBABRATA (MD)
Entity Type:Individual
Prefix:
First Name:DEBABRATA
Middle Name:
Last Name:GHOSH
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 1:673 E RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5935
Mailing Address - Country:US
Mailing Address - Phone:440-323-6422
Mailing Address - Fax:440-322-5574
Practice Address - Street 1:673 E RIVER ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5935
Practice Address - Country:US
Practice Address - Phone:440-323-6422
Practice Address - Fax:440-322-5574
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3089192084N0402X
OH35.083532208D00000X
OH3560835322084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2629114Medicaid
OH2629114Medicaid
OH2629114Medicaid