Provider Demographics
NPI:1538122809
Name:GHOSH, MIMI ANANYA (MD)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:ANANYA
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-685-6056
Mailing Address - Fax:614-685-7170
Practice Address - Street 1:1980 BETHEL RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1817
Practice Address - Country:US
Practice Address - Phone:614-685-6056
Practice Address - Fax:614-685-7170
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061147Medicaid
G73162Medicare UPIN
OHGH4036165Medicare PIN