Basic Information
| Provider Information | |||||||||
| NPI: | 1265788483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUBER | ||||||||
| FirstName: | LADOUGLAS | ||||||||
| MiddleName: | JAROD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 S. SCHMIDT ROAD | ||||||||
| Address2: | STE. 240 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604402634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303124505 | ||||||||
| FaxNumber: | 6303126651 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191021121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157627000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2012 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 036143816 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 036.143816 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.