Provider Demographics
NPI:1275558181
Name:CHATTERJEE, SUBHASIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHASIS
Middle Name:
Last Name:CHATTERJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SUBHA
Other - Middle Name:
Other - Last Name:CHATTERJEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 BAYLOR PLZ DEPT OF
Mailing Address - Street 2:MAIL STOP BCM390
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:713-798-8051
Mailing Address - Fax:
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:SUITE 0 520
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:713-798-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49586-020208G00000X
PAMD070814L208G00000X
NY231700-1208G00000X
MDD66027208G00000X
TN43199208G00000X
IL036-122987208G00000X
MN58316207L00000X
TX455982086S0102X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019569600001Medicaid
WI34891900Medicaid
PA110953Medicare PIN
WI34891900Medicaid
WII58452Medicare UPIN
PAI58452Medicare UPIN
PA1019569600001Medicaid