Provider Demographics
NPI:1700984192
Name:BALASUBRAMANIAM, RAJESWARI (MD)
Entity Type:Individual
Prefix:
First Name:RAJESWARI
Middle Name:
Last Name:BALASUBRAMANIAM
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 1:530 SOUTH ST STE G20
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2779
Mailing Address - Country:US
Mailing Address - Phone:724-836-5500
Mailing Address - Fax:724-836-1174
Practice Address - Street 1:530 SOUTH ST STE G20
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2779
Practice Address - Country:US
Practice Address - Phone:724-836-5500
Practice Address - Fax:724-836-3286
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051262L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1584951Medicaid
PA872169Medicare PIN
G31809Medicare UPIN