Healthcare Provider Details

I. General information

NPI: 1457096539
Provider Name (Legal Business Name): MILAN KUMAR NANGARU SUBBAIAH M.B.B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MILAN. S. KUMAR. N. M.B.B.S.

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 MITCHELL AVE # 42
BINGHAMTON NY
13903-1678
US

IV. Provider business mailing address

THE WRIGHT CENTER OF GRADUATE MEDICAL EDUCATION 501 S. WASHINGTON AVE., SUITE 1000
SCANTON PA
18505
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-8772
  • Fax:
Mailing address:
  • Phone: 570-866-3058
  • Fax: 570-343-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: