Provider Demographics
NPI:1306368519
Name:THAVARAPUTTA, SUBHANUDH (MD)
Entity Type:Individual
Prefix:
First Name:SUBHANUDH
Middle Name:
Last Name:THAVARAPUTTA
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 1:3600 FORBES AVENUE
Mailing Address - Street 2:FORBES TOWER - PLAZA LEVEL SUITE 140
Mailing Address - City:PITTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-647-6426
Mailing Address - Fax:412-647-5809
Practice Address - Street 1:3601 FIFTH AVENUE
Practice Address - Street 2:FALK MEDICAL BLDG, SUITE 562
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-586-9700
Practice Address - Fax:412-586-9726
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10059586390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program