Basic Information
| Provider Information | |||||||||
| NPI: | 1457096539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NANGARU SUBBAIAH | ||||||||
| FirstName: | MILAN KUMAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.B.B.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KUMAR. N. | ||||||||
| OtherFirstName: | MILAN. S. | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.B.B.S. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | THE WRIGHT CENTER OF GRADUATE MEDICAL EDUCATION | ||||||||
| Address2: | 501 S. WASHINGTON AVE., SUITE 1000 | ||||||||
| City: | SCANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708663058 | ||||||||
| FaxNumber: | 5703434800 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S. WASHINGTON AVE. | ||||||||
| Address2: | |||||||||
| City: | SCANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702903234 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2022 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.