Provider Demographics
NPI:1346206174
Name:GANGOPADHYAY, SUBROTO (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:SUBROTO
Middle Name:
Last Name:GANGOPADHYAY
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17510 W GRAND PKWY S STE 590
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2649
Mailing Address - Country:US
Mailing Address - Phone:281-565-6999
Mailing Address - Fax:281-565-7045
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:SUITE 460
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:281-565-6999
Practice Address - Fax:281-565-7045
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4646207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0705OtherBCBS
TX060065139OtherRR MEDICARE
TX134450908Medicaid
TX8054J3Medicare ID - Type Unspecified
TX134450908Medicaid