Provider Demographics
NPI:1104842137
Name:BANDYOPADHYAY, SUBHANKAR (MD)
Entity Type:Individual
Prefix:
First Name:SUBHANKAR
Middle Name:
Last Name:BANDYOPADHYAY
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 1:500 UNIVERSITY DR
Mailing Address - Street 2:PO BOX 850 , MAIL CODE H043
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-8955
Mailing Address - Fax:717-531-4587
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:MAIL CODE H043
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8955
Practice Address - Fax:717-531-4587
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446379207PP0204X
GA055175207P00000X
TXN55532080P0204X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F91472Medicare UPIN