Provider Demographics
NPI:1295740918
Name:SUBRAMANY, NARAYANA (MD)
Entity type:Individual
Prefix:
First Name:NARAYANA
Middle Name:
Last Name:SUBRAMANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 JOHNSONBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3483
Mailing Address - Country:US
Mailing Address - Phone:814-781-1188
Mailing Address - Fax:814-772-2702
Practice Address - Street 1:225 SOUTH ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-2033
Practice Address - Country:US
Practice Address - Phone:814-772-2485
Practice Address - Fax:814-772-2702
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038768L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119835OtherBLUE SHIELD NUMBER
PA0009798320003Medicaid
PAB37146Medicare UPIN
PA119835Medicare PIN
PA121272Medicare PIN