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General NPI Number Information
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NPI Number | 1770816118
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Entity Type | Individual
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Provider Name | SUBHASISH BOSE MD
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Gender | Male
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 2091 LANGHORNE RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-1428
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Country | US
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Telephone | 434-947-3954
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Fax | 877-583-4046
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Provider Business Mailing Address
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Address Line | 2450 W HUNTING PARK AVE 3RD FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1302
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Country | US
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Telephone | 215-707-2433
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Fax | 215-707-3677
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD448349
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 0101253245
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License Number State | VA
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