Provider Demographics
NPI:1205191871
Name:PATHMANATHAN, SUBA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBA
Middle Name:
Last Name:PATHMANATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MCMILLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1809
Mailing Address - Country:US
Mailing Address - Phone:220-564-4805
Mailing Address - Fax:220-564-4811
Practice Address - Street 1:120 MCMILLEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1809
Practice Address - Country:US
Practice Address - Phone:220-564-4805
Practice Address - Fax:220-564-4811
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66234207R00000X
MI4301100221207R00000X
OH35.141212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine