Provider Demographics
NPI:1174676753
Name:KARUMANCHI, SUBBIAN ANANTH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBBIAN
Middle Name:ANANTH
Last Name:KARUMANCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S. ANANTH
Other - Middle Name:
Other - Last Name:KARUMANCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:DANA 517
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-1018
Mailing Address - Fax:617-667-2913
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:DANA 517
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-1018
Practice Address - Fax:617-667-2913
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151960207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3199533Medicaid
MAA28654Medicare ID - Type Unspecified
MA3199533Medicaid