Provider Demographics
NPI:1376572172
Name:SUBHASH BHANOT, M.D., INC
Entity Type:Organization
Organization Name:SUBHASH BHANOT, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUBHASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-752-2555
Mailing Address - Street 1:140 STOLLINGS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-4035
Mailing Address - Country:US
Mailing Address - Phone:304-752-2555
Mailing Address - Fax:304-752-2561
Practice Address - Street 1:140 STOLLINGS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-4035
Practice Address - Country:US
Practice Address - Phone:304-752-2555
Practice Address - Fax:304-752-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV040663208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9348411Medicare PIN