Provider Demographics
NPI:1235391400
Name:SANGAM, SUBHASRI L (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASRI
Middle Name:L
Last Name:SANGAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUBHASRI
Other - Middle Name:L
Other - Last Name:MANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-422-8288
Mailing Address - Fax:570-426-2390
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-422-8288
Practice Address - Fax:570-426-2390
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433934208000000X, 2080N0001X
NJ25MA089618002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics