1356399075 NPI number — SUBBARAO GORTI M.D.

Table of content: SUBBARAO GORTI M.D. (NPI 1356399075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356399075 NPI number — SUBBARAO GORTI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORTI
Provider First Name:
SUBBARAO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356399075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1648 HUNTINGDON PIKE
Provider Second Line Business Mailing Address:
MEDICAL STAFF OFFICE 1ST FLR
Provider Business Mailing Address City Name:
MEADOWBROOK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19046-8001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-938-3450
Provider Business Mailing Address Fax Number:
215-938-3829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 TILLMAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENSALEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19020-2071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-914-4444
Provider Business Practice Location Address Fax Number:
215-245-2073
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD048575L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0013058950006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01305895-02 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1022053 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1024550 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0013058920001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 186650 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3832822 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0279193000 . This is a "IBC,KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0013058950002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080105711 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8696 . This is a "CLEAR CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810159612 . This is a "PHCS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA0049853 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 118031 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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