Basic Information
| Provider Information | |||||||||
| NPI: | 1588004071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHOSH | ||||||||
| FirstName: | RAKTIM | ||||||||
| MiddleName: | KUMAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2351 E 22ND ST | ||||||||
| Address2: | ST. VINCENT CHARITY MEDICAL CENTER, GRADUATE MEDICAL ED | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441153111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163632543 | ||||||||
| FaxNumber: | 2163632721 | ||||||||
| Practice Location | |||||||||
| Address1: | 3333 N CALVERT ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212182867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103665600 | ||||||||
| FaxNumber: | 4108894952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2013 | ||||||||
| LastUpdateDate: | 05/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | D86616 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.