Provider Demographics
NPI:1366471427
Name:SUBAKEESAN, P (MD)
Entity Type:Individual
Prefix:DR
First Name:P
Middle Name:
Last Name:SUBAKEESAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUBAKEESAN
Other - Middle Name:
Other - Last Name:P
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:48 SANDERSON ST STE 102
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2779
Practice Address - Country:US
Practice Address - Phone:413-794-7330
Practice Address - Fax:413-773-2691
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050563207RC0200X, 207RP1001X, 207RP1001X
MA1017317207RS0012X, 207RP1001X
NJ25MA07705100207RS0012X
NY236593207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I18604Medicare UPIN