Provider Demographics
NPI:1942863436
Name:GAUTAM, SUBARNA (MD)
Entity Type:Individual
Prefix:MR
First Name:SUBARNA
Middle Name:
Last Name:GAUTAM
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 1:1211 WILMINGTON AVE
Mailing Address - Street 2:UPMC JAMESON HOSPITAL
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105
Mailing Address - Country:US
Mailing Address - Phone:330-884-3573
Mailing Address - Fax:330-884-5688
Practice Address - Street 1:1211 WILMINGTON AVE
Practice Address - Street 2:UPMC JAMESON HOSPITAL
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105
Practice Address - Country:US
Practice Address - Phone:724-658-9001
Practice Address - Fax:330-884-5688
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD477958208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program