Provider Demographics
NPI:1881898443
Name:GHOSH, SIDHARTH NONESUPPLIED (MD)
Entity type:Individual
Prefix:DR
First Name:SIDHARTH
Middle Name:NONESUPPLIED
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:PO BOX 57334
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7334
Mailing Address - Country:US
Mailing Address - Phone:281-942-8001
Mailing Address - Fax:281-724-1919
Practice Address - Street 1:500 W MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4220
Practice Address - Country:US
Practice Address - Phone:281-942-8001
Practice Address - Fax:281-724-1919
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194704601Medicaid
2775912056OtherMYUTMB 2775912056-COMMERCIAL NUMBER
2775912056OtherMYUTMB 2775912056-COMMERCIAL NUMBER