MEDICARE: SUBBARAO GORTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD048575L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	080105711	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01305895-02	OTHER	PA	AMERICHOICE
3	1022053	OTHER	PA	KEYSTONE MERCY
4	1024550	OTHER	PA	UNITED HEALTHCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	186650	OTHER	PA	HIGHMARK BLUE SHIELD
7	3832822	OTHER	PA	CIGNA
8	0279193000	OTHER	PA	IBC,KEYSTONE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	8696	OTHER	PA	CLEAR CARE
12	810159612	OTHER	PA	PHCS
13	PA0049853	OTHER	PA	TRICARE
14	118031	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1356399075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUBBARAO GORTI M.D.

Provider Business Mailing Address
First Line	:	1648 HUNTINGDON PIKE
Second Line	:	MEDICAL STAFF OFFICE 1ST FLR
City	:	MEADOWBROOK
State	:	PA
Zip	:	19046-8001
Country	:	US
Telephone Number	:	215-938-3450
Fax Number	:	215-938-3829

Provider Business Practice Location Address
First Line	:	3300 TILLMAN DR
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-2071
Country	:	US
Telephone Number	:	215-914-4444
Fax Number	:	215-245-2073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/21/2021

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