Provider Demographics
NPI:1205975398
Name:GUMBER, SUBHASH (MD)
Entity type:Individual
Prefix:
First Name:SUBHASH
Middle Name:
Last Name:GUMBER
Suffix:
Gender:M
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:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-1669
Practice Address - Street 1:530 NEW WAVERLY PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7414
Practice Address - Country:US
Practice Address - Phone:919-858-0892
Practice Address - Fax:919-342-3472
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500921207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC37928OtherBCBS
80622OtherMEDCOST
1752215OtherUNITED HEALTHCARE RURAL
8940678OtherCIGNA
NC8937928Medicaid
110167667OtherRAILROAD MEDICARE
2953904OtherUNITED HEALTHCARE
NC2213714BMedicare PIN
1752215OtherUNITED HEALTHCARE RURAL