Provider Demographics
NPI:1356370142
Name:BHANOT, SUBHASH (MD)
Entity type:Individual
Prefix:
First Name:SUBHASH
Middle Name:
Last Name:BHANOT
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 1:140 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
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12647208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131001000Medicaid
C35014Medicare UPIN
WVWV3244AMedicare PIN