Provider Demographics
NPI:1558937722
Name:BISWAS, SOM SUBHRO
Entity Type:Individual
Prefix:
First Name:SOM
Middle Name:SUBHRO
Last Name:BISWAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 ADAMS AVE
Mailing Address - Street 2:APT 210
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-5021
Mailing Address - Country:US
Mailing Address - Phone:901-448-5364
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF RADIOLOGY, 865 JEFFERSON AVE
Practice Address - Street 2:SUITE F 150, CHANDLER BUILDING
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:90144
Practice Address - Country:US
Practice Address - Phone:901-448-4456
Practice Address - Fax:901-448-1248
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program