Provider Demographics
NPI:1770593238
Name:M RITA GHOSH MD PC
Entity type:Organization
Organization Name:M RITA GHOSH MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAHASHWETA
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:GHOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-738-0053
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D09303Medicare UPIN
G02037Medicare ID - Type Unspecified