Provider Demographics
NPI:1558756791
Name:GHOSH, PRIYANKA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
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 1:1900 OFARRELL ST STE 190
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1372
Mailing Address - Country:US
Mailing Address - Phone:650-306-9490
Mailing Address - Fax:
Practice Address - Street 1:1900 OFARRELL ST STE 190
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1372
Practice Address - Country:US
Practice Address - Phone:650-306-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-04
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA169421A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty