Provider Demographics
NPI:1043230824
Name:BISWAS, SHANKHA SUVRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANKHA
Middle Name:SUVRA
Last Name:BISWAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4500 BROCKTON AVE STE 317
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4028
Mailing Address - Country:US
Mailing Address - Phone:951-788-3930
Mailing Address - Fax:951-788-3920
Practice Address - Street 1:901 SAN BERNARDINO RD STE 102
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4988
Practice Address - Country:US
Practice Address - Phone:951-788-3930
Practice Address - Fax:951-788-3920
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA95947208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI60542Medicare UPIN
CACQ894TMedicare PIN