Provider Demographics
NPI:1336896794
Name:SUBBA, DAMBER BAHADUR
Entity Type:Individual
Prefix:
First Name:DAMBER
Middle Name:BAHADUR
Last Name:SUBBA
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 1:1633 33RD AVE S APT 104
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6172
Mailing Address - Country:US
Mailing Address - Phone:701-936-1538
Mailing Address - Fax:
Practice Address - Street 1:1323 23RD ST S STE D
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3759
Practice Address - Country:US
Practice Address - Phone:701-526-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist