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General NPI Number Information
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NPI Number | 1053341685
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Entity Type | Individual
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Provider Name | SUBROTO BHATTACHARYA MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 1 ROOSEVELT AVE STE 204
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City | PEABODY
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State | MA
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Zip | 01960-2227
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Country | US
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Telephone | 978-762-6262
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Fax | 978-750-8312
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Provider Business Mailing Address
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Address Line | 1 ROOSEVELT AVE STE 204
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City | PEABODY
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State | MA
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Zip | 01960-2227
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Country | US
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Telephone | 978-762-6262
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Fax | 978-750-8312
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207328
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License Number State | MA
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