Provider Demographics
NPI:1265419741
Name:SUBRAMANIAN, RAJESH (MBBS)
Entity type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:M
Credentials:MBBS
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 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4918
Practice Address - Country:US
Practice Address - Phone:425-339-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18209207RC0000X
WAMD60134221207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR99580OtherBCBS
MS06451269Medicaid
TN4146205OtherBCBS
WA0280786OtherSTATE L&I
TN3896247Medicaid
TNP00378333OtherRAIL ROAD MEDICARE
WA0280775OtherSTATE L&I
TN000000031086OtherTLC
TN7216564OtherAETNA
MSP00372270OtherRAIL ROAD MEDICARE
WA0280801OtherSTATE L&I
06110013301OtherQUALCHOICE
WA0280801OtherSTATE L&I
TN3896247Medicare PIN
MS06451269Medicaid
MS060000887Medicare PIN