Basic Information
| Provider Information | |||||||||
| NPI: | 1730113648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUBBARAO | ||||||||
| FirstName: | ARAGAM | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 STATE STREET, SUITE 16 LL | ||||||||
| Address2: | REGIONAL HEALTH SERVICES, INC. | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165011360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777100 | ||||||||
| FaxNumber: | 8148772939 | ||||||||
| Practice Location | |||||||||
| Address1: | 4372 ROUTE 6 | ||||||||
| Address2: | KANE EMERGENCY DEPARTMENT | ||||||||
| City: | KANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148378585 | ||||||||
| FaxNumber: | 8148377905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 03/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD024905E | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000908106 | 05 | PA | MEDICAID |