Provider Demographics
NPI:1376537621
Name:PROOTHI, SUBHASH C (MD)
Entity Type:Individual
Prefix:
First Name:SUBHASH
Middle Name:C
Last Name:PROOTHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:STE 403
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:610-867-3115
Mailing Address - Fax:610-867-6991
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:STE 403
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:610-867-3115
Practice Address - Fax:610-867-6991
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2013-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD022180E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006772140001Medicaid
B35835Medicare UPIN
PA0006772140001Medicaid