NPIMap

Organization Active NPI

Trumbull Internal Medicine Inc.

  • Internal Medicine Physician
  • Warren, OH
National Provider Identifier
1861533507
Registry record updated Aug 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
35069121K Issued in OH
Legal business name
TRUMBULL INTERNAL MEDICINE INC.
Practice address
628 Niles Cortland Rd SE
Suite # 102
Warren, OH 44484-2473
Phone
(330) 856-8148
Fax
(330) 856-8159
NPI assigned
Feb 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Subhash Khaterpaul, MD
Title
President Dentist
Phone
(330) 856-8148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 35069121K OH Primary

Addresses

Primary practice location

628 Niles Cortland Rd SE
Suite # 102
Warren, OH 44484-2473

Mailing address

628 Niles Cortland Rd SE
Suite #102
Warren, OH 44484-2473
Phone (330) 856-8148

Other identifiers 8

IdentifierTypeStateIssuer
593088331009OtherHOWLAND
J69121OtherHEWHNFALLS SYMMECARE
331664OtherHEALTH ASSURANCE
000000379459OtherANTHEM
0197353MedicaidOH
5583069OtherAETNA
92344OtherQUALCHOICE
593088331008OtherMEDICAL MUTUAL

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439856000000",
    "number": "1861533507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 NILES CORTLAND RD SE",
            "address_2": "SUITE #102",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444842473",
            "telephone_number": "330-856-8148",
            "fax_number": "330-856-8159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 NILES CORTLAND RD SE",
            "address_2": "SUITE # 102",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444842473",
            "telephone_number": "330-856-8148",
            "fax_number": "330-856-8159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUMBULL INTERNAL MEDICINE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2015-08-18",
        "status": "A",
        "authorized_official_last_name": "KHATERPAUL",
        "authorized_official_first_name": "SUBHASH",
        "authorized_official_title_or_position": "PRESIDENT DENTIST",
        "authorized_official_telephone_number": "330-856-8148",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35069121K",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOWLAND",
            "identifier": "593088331009",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEWHNFALLS SYMMECARE",
            "identifier": "J69121",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE",
            "identifier": "331664",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000379459",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0197353",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5583069",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "92344",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL",
            "identifier": "593088331008",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.