Provider Demographics
NPI:1508605353
Name:SUBBIAH, MRINAL ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:MRINAL
Middle Name:ANTHONY
Last Name:SUBBIAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 VAN BUREN RD APT 1
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2407
Mailing Address - Country:US
Mailing Address - Phone:973-954-3523
Mailing Address - Fax:
Practice Address - Street 1:8815 GERMANTOWN AVE FL 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2722
Practice Address - Country:US
Practice Address - Phone:215-248-8907
Practice Address - Fax:215-753-2005
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHS000239L207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program