Basic Information
| Provider Information | |||||||||
| NPI: | 1710292446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PINNAKA | ||||||||
| FirstName: | SUBHASH | ||||||||
| MiddleName: | CHANDRA BOSE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 KIM LN | ||||||||
| Address2: | |||||||||
| City: | WINDBER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159638722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144931939 | ||||||||
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| Practice Location | |||||||||
| Address1: | STATE RT. 1014 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157790111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244598000 | ||||||||
| FaxNumber: | 7244594498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2010 | ||||||||
| LastUpdateDate: | 08/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD458405 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.