Provider Demographics
NPI:1003874306
Name:BARUA, SUBRATA P (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBRATA
Middle Name:P
Last Name:BARUA
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:RR 6
Mailing Address - Street 2:WALTON TEA ROOM ROAD
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-9806
Mailing Address - Country:US
Mailing Address - Phone:724-527-5959
Mailing Address - Fax:724-523-5135
Practice Address - Street 1:RR 6
Practice Address - Street 2:WALTON TEA ROOM ROAD
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9806
Practice Address - Country:US
Practice Address - Phone:724-527-5959
Practice Address - Fax:724-523-5135
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032012L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28683Medicare UPIN