Provider Demographics
NPI:1821282849
Name:SUBRAMANIAN, VAIRAVAN SARAVANAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VAIRAVAN
Middle Name:SARAVANAN
Last Name:SUBRAMANIAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3600 GASTON AVE STE 1205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1812
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:STE 685
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-566-7765
Practice Address - Fax:469-467-9437
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8994208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX663120OtherMEDICARE
TX282618205Medicaid
TX282618204OtherMEDICAID OTHER
TX282618205Medicaid
TX282618203Medicaid