Provider Demographics
NPI:1518222983
Name:GOSWAMI, AASHUTOSH (MD)
Entity Type:Individual
Prefix:
First Name:AASHUTOSH
Middle Name:
Last Name:GOSWAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASIT
Other - Middle Name:
Other - Last Name:GOSWAMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:95 S PAGOSA BLVD
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8329
Practice Address - Country:US
Practice Address - Phone:970-731-3700
Practice Address - Fax:970-731-3708
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-44573207Q00000X
CODR.0069944208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026327300Medicaid
IA1518222983Medicaid