Provider Demographics
NPI:1407083397
Name:VIDHYA SUBRAMANIAN, MD PA
Entity Type:Organization
Organization Name:VIDHYA SUBRAMANIAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBRAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-532-7514
Mailing Address - Street 1:PO BOX 18497
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-8497
Mailing Address - Country:US
Mailing Address - Phone:832-532-7514
Mailing Address - Fax:832-532-7801
Practice Address - Street 1:4780 SWEETWATER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3162
Practice Address - Country:US
Practice Address - Phone:832-532-7514
Practice Address - Fax:832-532-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4568207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M4568OtherTEXAS MEDICAL LICENSE