Provider Demographics
NPI:1619404233
Name:ANBALAGAN, SAMINATHAN (MBBS, MD)
Entity Type:Individual
Prefix:DR
First Name:SAMINATHAN
Middle Name:
Last Name:ANBALAGAN
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:318-868-6430
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-415-1055
Practice Address - Fax:251-415-1045
Is Sole Proprietor?:No
Enumeration Date:2017-05-13
Last Update Date:2023-08-22
Deactivation Date:2017-12-18
Deactivation Code:
Reactivation Date:2018-06-22
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL463662080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program