Provider Demographics
NPI:1093959439
Name:DORAISWAMI, SUBBIAH (MD)
Entity Type:Individual
Prefix:
First Name:SUBBIAH
Middle Name:
Last Name:DORAISWAMI
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 1:560 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2510
Mailing Address - Country:US
Mailing Address - Phone:617-484-7635
Mailing Address - Fax:
Practice Address - Street 1:560 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-2510
Practice Address - Country:US
Practice Address - Phone:617-484-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine