Provider Demographics
NPI:1518071547
Name:SUBRAMANIAN, VIJAYALAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIJAY
Other - Middle Name:
Other - Last Name:SUBRAMANIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7610 CARROLL AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-891-6080
Mailing Address - Fax:301-891-6091
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-891-6080
Practice Address - Fax:301-891-6091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019677208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics