Provider Demographics
NPI:1912197443
Name:BALASUBRAMANYA, ARCHANA (MD)
Entity Type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:BALASUBRAMANYA
Suffix:
Gender:F
Credentials: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 382964
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35238-2964
Mailing Address - Country:US
Mailing Address - Phone:423-767-4327
Mailing Address - Fax:425-250-8495
Practice Address - Street 1:1817 SURREY OAKS LN
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-1761
Practice Address - Country:US
Practice Address - Phone:423-767-4327
Practice Address - Fax:423-928-1353
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000585Medicare PIN