Healthcare Provider Details

I. General information

NPI: 1154797991
Provider Name (Legal Business Name): ROGIN SUBEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 BIENVILLE BLVD STE B
OCEAN SPRINGS MS
39564-5710
US

IV. Provider business mailing address

3704 BIENVILLE BLVD STE B
OCEAN SPRINGS MS
39564-5710
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-4040
  • Fax: 228-872-3612
Mailing address:
  • Phone: 228-872-4040
  • Fax: 315-464-3751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number31662
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: