Provider Demographics
NPI:1578758488
Name:SWARNA BALASUBRAMANIAM MD
Entity Type:Organization
Organization Name:SWARNA BALASUBRAMANIAM MD
Other - Org Name:SUGAR LAND COLON AND RECTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SWARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASUBRAMANIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-277-2121
Mailing Address - Street 1:DEPT 893 P O BOX 4346
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210
Mailing Address - Country:US
Mailing Address - Phone:281-277-2121
Mailing Address - Fax:281-277-2125
Practice Address - Street 1:16659 SOUTHWEST FWY # 561
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-277-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00Y177Medicare PIN