Healthcare Provider Details

I. General information

NPI: 1104842137
Provider Name (Legal Business Name): SUBHANKAR BANDYOPADHYAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR MAIL CODE H043
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

500 UNIVERSITY DR PO BOX 850 , MAIL CODE H043
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8955
  • Fax: 717-531-4587
Mailing address:
  • Phone: 717-531-8955
  • Fax: 717-531-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberMD446379
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number055175
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberN5553
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN5553
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: