Provider Demographics
NPI:1154434108
Name:THOTA, SUBHASHINI (MD)
Entity type:Individual
Prefix:
First Name:SUBHASHINI
Middle Name:
Last Name:THOTA
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 1:130 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE H321
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3121
Mailing Address - Country:US
Mailing Address - Phone:484-337-4097
Mailing Address - Fax:484-337-4082
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:SUITE H321
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-4097
Practice Address - Fax:484-337-4082
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429381207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI653232Medicare UPIN
PA101728310-01OtherAMERICHOICE-TORRESDALE
PA101728310-02OtherAMERICHOICE -FRANKFORD
PA105014JL1Medicare PIN
PA2764678000OtherKEYSTONE IBC
PAI653232Medicare UPIN
PA1017283100003Medicaid
PA34936OtherHEALTH PARTNERS-FRANKFORD
PA1897962OtherHIGHMARK BLUE SHIELD
PA30035897OtherKEYSTONE MERCY
PA101728310-03OtherAMERICHOICE- BUCKS
PA1017283100002Medicaid
PA34937OtherHEALTH PARTNERS-BUCKS
PA1017283100001Medicaid