Provider Demographics
NPI:1104897370
Name:SUBBIAH, SHANTHI (MD)
Entity type:Individual
Prefix:DR
First Name:SHANTHI
Middle Name:
Last Name:SUBBIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CHEWS LANDING RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2769
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:1405 CHEWS LANDING RD
Practice Address - Street 2:SUITE 14
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2769
Practice Address - Country:US
Practice Address - Phone:856-782-3300
Practice Address - Fax:856-504-8029
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08313500207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8245100Medicaid
NJ25MA08313500OtherLICENSE