Provider Demographics
NPI:1942586334
Name:GHOSH, NINA (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
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 1:75 PETERBOROUGH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4311
Mailing Address - Country:US
Mailing Address - Phone:617-670-0536
Mailing Address - Fax:
Practice Address - Street 1:75 PETERBOROUGH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4311
Practice Address - Country:US
Practice Address - Phone:617-670-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249443207RC0000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology