Provider Demographics
NPI:1447451539
Name:GOSWAMI, AMITABH U (DO, MPH)
Entity type:Individual
Prefix:
First Name:AMITABH
Middle Name:U
Last Name:GOSWAMI
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7255 N CEDAR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3831
Mailing Address - Country:US
Mailing Address - Phone:559-478-4757
Mailing Address - Fax:559-323-4143
Practice Address - Street 1:7255 N. CEDAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2930
Practice Address - Country:US
Practice Address - Phone:559-478-4757
Practice Address - Fax:559-323-4143
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9044207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A90440Medicare PIN
CAGZ931YMedicare PIN
CAGZ931XMedicare PIN