Provider Demographics
NPI:1477649929
Name:BALASUBRAMANIAM, SWARNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SWARNA
Middle Name:
Last Name:BALASUBRAMANIAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 HIGHWAY 6 # 112
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4401
Mailing Address - Country:US
Mailing Address - Phone:281-277-2121
Mailing Address - Fax:281-277-2125
Practice Address - Street 1:20403 UNIVERSITY BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4978
Practice Address - Country:US
Practice Address - Phone:281-277-2121
Practice Address - Fax:281-277-2125
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238748208C00000X
TXM5623208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02733062Medicaid
NY7013F1Medicare ID - Type Unspecified
NY02733062Medicaid