Provider Demographics
NPI:1073574174
Name:SUBRAMANIAM, BALACHUNDHAR (MBBS, MD)
Entity Type:Individual
Prefix:
First Name:BALACHUNDHAR
Middle Name:
Last Name:SUBRAMANIAM
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PROSPECT HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6910
Mailing Address - Country:US
Mailing Address - Phone:617-754-2675
Mailing Address - Fax:
Practice Address - Street 1:22 PROSPECT HILL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6910
Practice Address - Country:US
Practice Address - Phone:617-754-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216718207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology