Provider Demographics
NPI:1700087145
Name:GHOSHAL, ASISH (MD)
Entity Type:Individual
Prefix:DR
First Name:ASISH
Middle Name:
Last Name:GHOSHAL
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 1:6601 COYLE AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6311
Mailing Address - Country:US
Mailing Address - Phone:916-967-1288
Mailing Address - Fax:916-967-0518
Practice Address - Street 1:6601 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6311
Practice Address - Country:US
Practice Address - Phone:916-967-1288
Practice Address - Fax:916-967-0518
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA420552084P0015X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A420550Medicaid
CA00A420550Medicaid
00A420550Medicare ID - Type Unspecified