Healthcare Provider Details

I. General information

NPI: 1710292446
Provider Name (Legal Business Name): SUBHASH CHANDRA BOSE PINNAKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STATE RT. 1014
TORRANCE PA
15779-0111
US

IV. Provider business mailing address

315 KIM LN
WINDBER PA
15963-8722
US

V. Phone/Fax

Practice location:
  • Phone: 724-459-8000
  • Fax: 724-459-4498
Mailing address:
  • Phone: 914-493-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD458405
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: