Provider Demographics
NPI:1356750756
Name:SUBBARAO, KANTA (MBBS)
Entity type:Individual
Prefix:DR
First Name:KANTA
Middle Name:
Last Name:SUBBARAO
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:E
Other - Middle Name:KANTA
Other - Last Name:SUBBARAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBBS
Mailing Address - Street 1:33 NORTH DR
Mailing Address - Street 2:ROOM 3E 13C.1
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-3203
Mailing Address - Country:US
Mailing Address - Phone:301-451-3839
Mailing Address - Fax:301-480-4749
Practice Address - Street 1:33 NORTH DR
Practice Address - Street 2:ROOM 3E 13C.1
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-3203
Practice Address - Country:US
Practice Address - Phone:301-451-3839
Practice Address - Fax:301-480-4749
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0573552080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases