Provider Demographics
NPI:1053471672
Name:GOSWAMI, NABA (MD)
Entity type:Individual
Prefix:MR
First Name:NABA
Middle Name:
Last Name:GOSWAMI
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 6230
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0722
Mailing Address - Country:US
Mailing Address - Phone:740-695-2609
Mailing Address - Fax:740-695-2877
Practice Address - Street 1:109 PLAZA DR
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-695-2609
Practice Address - Fax:740-695-2877
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069006207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0948149Medicaid
OH110141077OtherRAILROAD MEDICARE
B42741Medicare UPIN
OH0814721Medicare ID - Type Unspecified