Provider Demographics
NPI:1386680445
Name:GHORAI, SUJOY K (MD)
Entity Type:Individual
Prefix:
First Name:SUJOY
Middle Name:K
Last Name:GHORAI
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 1:4225 HOYT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2351
Mailing Address - Country:US
Mailing Address - Phone:425-259-3122
Mailing Address - Fax:
Practice Address - Street 1:4225 HOYT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2351
Practice Address - Country:US
Practice Address - Phone:425-259-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041993207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0161778OtherLABOR AND INDUSTRY
WAMD00041993OtherSTATE LICENSE NUMBER
WA8312241Medicaid
WAMD00041993OtherSTATE LICENSE NUMBER
WAGAB29345Medicare PIN