Healthcare Provider Details

I. General information

NPI: 1548109093
Provider Name (Legal Business Name): SUBARNA BAGCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 YORK RD STE 14
TIMONIUM MD
21093-6211
US

IV. Provider business mailing address

2635 N CALVERT ST APT 3
BALTIMORE MD
21218-5595
US

V. Phone/Fax

Practice location:
  • Phone: 206-779-5445
  • Fax:
Mailing address:
  • Phone: 206-779-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: