Provider Demographics
NPI:1477554913
Name:GHOSH, SUBRATA (MD)
Entity type:Individual
Prefix:DR
First Name:SUBRATA
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 1:400 W MEDICAL CENTER BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4403
Mailing Address - Country:US
Mailing Address - Phone:713-335-3600
Mailing Address - Fax:713-335-3605
Practice Address - Street 1:400 W MEDICAL CENTER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:713-335-3600
Practice Address - Fax:713-335-3605
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2020-08-18
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
TXL4952207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155025302Medicaid
TX8C2745Medicare PIN
TXH33531Medicare UPIN