Provider Demographics
NPI:1629021530
Name:SUBRAMANIAN, V. BALA (MD)
Entity Type:Individual
Prefix:DR
First Name:V.
Middle Name:BALA
Last Name:SUBRAMANIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4915 AUBURN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2636
Mailing Address - Country:US
Mailing Address - Phone:301-907-3939
Mailing Address - Fax:301-656-3943
Practice Address - Street 1:4141 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2415
Practice Address - Country:US
Practice Address - Phone:703-461-3556
Practice Address - Fax:703-461-8075
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101229647207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5849519Medicaid
VA5849519Medicaid
VAG23111Medicare UPIN