Provider Demographics
NPI:1477663425
Name:GHOSH, BHARATI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHARATI
Middle Name:
Last Name:GHOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9645 MONTE VISTA AVE
Mailing Address - Street 2:SUITE # 304
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2236
Mailing Address - Country:US
Mailing Address - Phone:909-625-3396
Mailing Address - Fax:
Practice Address - Street 1:9645 MONTE VISTA AVE
Practice Address - Street 2:SUITE # 304
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2236
Practice Address - Country:US
Practice Address - Phone:909-625-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA342300Medicaid
CAE99860Medicare UPIN