Provider Demographics
NPI:1265730212
Name:SUBBU HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:SUBBU HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUBRAMANIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VARADARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:301-434-5590
Mailing Address - Street 1:10309 GLENMORE DR
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1202
Mailing Address - Country:US
Mailing Address - Phone:301-434-5590
Mailing Address - Fax:301-434-5590
Practice Address - Street 1:10309 GLENMORE DR
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1202
Practice Address - Country:US
Practice Address - Phone:301-434-5590
Practice Address - Fax:301-434-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW13537113261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCN 602500730OtherCMS MEDICARE