Provider Demographics
NPI:1588004071
Name:GHOSH, RAKTIM KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKTIM
Middle Name:KUMAR
Last Name:GHOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2351 E 22ND ST
Mailing Address - Street 2:ST. VINCENT CHARITY MEDICAL CENTER, GRADUATE MEDICAL ED
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3111
Mailing Address - Country:US
Mailing Address - Phone:216-363-2543
Mailing Address - Fax:216-363-2721
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-366-5600
Practice Address - Fax:410-889-4952
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD86616207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease