| Devabrata Ganguly MD PA | |
|
3144 Clarksville St Paris TX 75460-8002 | |
| (903) 784-8700 | |
| (903) 427-0503 |
| Full Name | Devabrata Ganguly MD PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 3144 Clarksville St, Paris, Texas |
| Authorized Official Name and Position | Devabrata Ganguly (OWNER) |
| Authorized Official Contact | 9034270500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Devabrata Ganguly MD PA 3144 Clarksville St Paris TX 75460-8002 Ph: (903) 784-8700 | Devabrata Ganguly MD PA 3144 Clarksville St Paris TX 75460-8002 Ph: (903) 784-8700 |
| NPI Number | 1891049342 |
|---|---|
| Provider Enumeration Date | 11/06/2012 |
| Last Update Date | 06/29/2016 |
| Medicare PECOS PAC ID | 9537480561 |
|---|---|
| Medicare Enrollment ID | O20150603000630 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891049342 | NPI | - | NPPES |
| 412743 | Other | TX | MEDICARE PTAN |
| 044968802 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | K7287 (Texas) | Secondary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | K7287 (Texas) | Primary |
| Provider Name | Devabrata Ganguly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225077274 PECOS PAC ID: 1254339690 Enrollment ID: I20061120000389 |
| Provider Name | Coy Allen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346992401 PECOS PAC ID: 6204222144 Enrollment ID: I20220609001646 |
| Provider Name | Natalie Nicole Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033737424 PECOS PAC ID: 0941698872 Enrollment ID: I20240724002760 |
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