Provider Demographics
NPI:1013991082
Name:GHOSH, CHIRANTAN (MD)
Entity Type:Individual
Prefix:
First Name:CHIRANTAN
Middle Name:
Last Name:GHOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 51ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2460
Mailing Address - Country:US
Mailing Address - Phone:319-294-1899
Mailing Address - Fax:319-294-1773
Practice Address - Street 1:1951 51ST ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2460
Practice Address - Country:US
Practice Address - Phone:319-294-1899
Practice Address - Fax:319-294-1773
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27554207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1066704Medicaid
IA48937OtherBLUE CROSS BLUE SHIELD
IA16671Medicare ID - Type Unspecified
IAE54250Medicare UPIN