Provider Demographics
NPI:1407052228
Name:BASKARARAJAN, VENKATASUBRAMANIAN (MD)
Entity Type:Individual
Prefix:
First Name:VENKATASUBRAMANIAN
Middle Name:
Last Name:BASKARARAJAN
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 1:1 LINCOLN PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3262
Mailing Address - Country:US
Mailing Address - Phone:601-288-8050
Mailing Address - Fax:601-288-8058
Practice Address - Street 1:1 LINCOLN PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3262
Practice Address - Country:US
Practice Address - Phone:601-288-8050
Practice Address - Fax:601-288-8058
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS658-L2084P0800X
MS206582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry