Provider Demographics
NPI:1447231949
Name:GOSWAMI, ATUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ATUL
Middle Name:
Last Name:GOSWAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ATUL
Other - Middle Name:
Other - Last Name:GOSWAMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1037 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1449
Mailing Address - Country:US
Mailing Address - Phone:330-923-1400
Mailing Address - Fax:330-923-1427
Practice Address - Street 1:1037 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310
Practice Address - Country:US
Practice Address - Phone:330-923-1400
Practice Address - Fax:330-923-1427
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0449G174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0574178Medicaid
OH0574178Medicaid
OHA15683Medicare UPIN