Provider Demographics
NPI:1487073037
Name:SUBBASWAMY, APURVA (MD)
Entity type:Individual
Prefix:
First Name:APURVA
Middle Name:
Last Name:SUBBASWAMY
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 1:236 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1348
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-498-8160
Practice Address - Street 1:100 PROVIDENCE WAY STE 200
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:859-260-5370
Practice Address - Fax:859-260-5370
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51199208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100534790Medicaid