Provider Demographics
NPI:1467630756
Name:GHOSH, PARTHASARATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:PARTHASARATHI
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:PO BOX 112
Mailing Address - Street 2:STATEVILLE CORRECTION CENTER
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-0112
Mailing Address - Country:US
Mailing Address - Phone:815-727-3607
Mailing Address - Fax:815-722-7039
Practice Address - Street 1:DIVISION ST AND ROUTE 53
Practice Address - Street 2:STATEVILLE CORRECTION CENTER
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60434-0112
Practice Address - Country:US
Practice Address - Phone:815-727-3607
Practice Address - Fax:815-722-7039
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine