Provider Demographics
NPI:1356521173
Name:GHOSH, MAHASHWETA RITA (MD)
Entity type:Individual
Prefix:
First Name:MAHASHWETA
Middle Name:RITA
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 1:15200 SHADY GROVE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6256
Mailing Address - Country:US
Mailing Address - Phone:301-738-0053
Mailing Address - Fax:301-738-1058
Practice Address - Street 1:15200 SHADY GROVE RD STE 400
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6256
Practice Address - Country:US
Practice Address - Phone:301-738-0053
Practice Address - Fax:301-738-1058
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D09303Medicare UPIN