Provider Demographics
NPI:1790890291
Name:SEETHARAMA, SUBRAMANI (MD)
Entity Type:Individual
Prefix:
First Name:SUBRAMANI
Middle Name:
Last Name:SEETHARAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-545-5107
Mailing Address - Fax:860-545-5593
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 604
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-545-5107
Practice Address - Fax:860-545-5593
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0337182081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF67057Medicare UPIN