Provider Demographics
NPI:1639319700
Name:GHOSH, CHANDRANI
Entity Type:Individual
Prefix:
First Name:CHANDRANI
Middle Name:
Last Name:GHOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANDRANI
Other - Middle Name:
Other - Last Name:GHOSHDASGUPTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:630 MERRICK ST
Mailing Address - Street 2:APT 807
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3950
Mailing Address - Country:US
Mailing Address - Phone:914-610-9223
Mailing Address - Fax:
Practice Address - Street 1:4707 SAINT ANTOINE ST
Practice Address - Street 2:OLD HUTZEL HOSPITAL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1427
Practice Address - Country:US
Practice Address - Phone:313-745-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091663207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology