Healthcare Provider Details

I. General information

NPI: 1083698955
Provider Name (Legal Business Name): SURABHI AMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SURABHI MUKHOPADHYAY M.D.

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E ROOSEVELT ST
PHOENIX AZ
85008-4948
US

IV. Provider business mailing address

2929 E THOMAS RD
PHOENIX AZ
85016-8034
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5011
  • Fax:
Mailing address:
  • Phone: 602-470-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME93007
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number38050
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: