Provider Demographics
NPI:1518938000
Name:WADHWA, SUBODH K (MD)
Entity Type:Individual
Prefix:
First Name:SUBODH
Middle Name:K
Last Name:WADHWA
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 1:1049 SUMMITT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3464
Mailing Address - Country:US
Mailing Address - Phone:513-423-1399
Mailing Address - Fax:513-423-4790
Practice Address - Street 1:1049 SUMMITT DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3464
Practice Address - Country:US
Practice Address - Phone:513-423-1399
Practice Address - Fax:513-423-4790
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0464672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0485603Medicaid
OHWA0512053Medicare ID - Type UnspecifiedPROVIDER NUMBER
OH0485603Medicaid