Basic Information
| Provider Information | |||||||||
| NPI: | 1245438035 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATUL GOSWAMI, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1037 N MAIN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443101449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309231400 | ||||||||
| FaxNumber: | 3309231427 | ||||||||
| Practice Location | |||||||||
| Address1: | 1037 N MAIN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443101449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309231400 | ||||||||
| FaxNumber: | 3309231427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 11/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | GOSWAMI | ||||||||
| AuthorizedOfficialFirstName: | ATUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 3309231400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 35050449G | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2283434 | 05 | OH | MEDICAID |