Provider Demographics
NPI:1205984614
Name:SUBRAMANYA, ARAGAM KRISHNARAO (MD)
Entity type:Individual
Prefix:DR
First Name:ARAGAM
Middle Name:KRISHNARAO
Last Name:SUBRAMANYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:320 BOLTON ST
Mailing Address - Street 2:102
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3980
Mailing Address - Country:US
Mailing Address - Phone:508-481-7180
Mailing Address - Fax:508-624-9374
Practice Address - Street 1:320 BOLTON ST
Practice Address - Street 2:102
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3980
Practice Address - Country:US
Practice Address - Phone:508-481-7180
Practice Address - Fax:508-624-9374
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA34888207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB28039OtherBLUE CROSS & BLUES HIELD
MA034888OtherALL OTHER INSURANCES
MA034888OtherTUFTS HEALTH
MA9720111Medicaid
MA2000000134OtherHARVARD PILGRIM
MAM13290Medicare ID - Type Unspecified
MA9720111Medicaid