Provider Demographics
NPI:1992868277
Name:SANJAY GHOSH PHD MD PC
Entity Type:Organization
Organization Name:SANJAY GHOSH PHD MD PC
Other - Org Name:SANJAY GHOSH PHD MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHD MD PC
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-390-2288
Mailing Address - Street 1:1080 CAROLINE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1080 CAROLINE DR
Practice Address - Street 2:STE 200
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4902
Practice Address - Country:US
Practice Address - Phone:636-390-2288
Practice Address - Fax:636-390-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2636376OtherOTHER ID NUMBER
2636376OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MO506132208Medicaid
MO6583290001Medicare NSC