Provider Demographics
NPI:1740252469
Name:SUBBIAH, MURUGANANTHAN PUDUNAGAR (MD)
Entity type:Individual
Prefix:
First Name:MURUGANANTHAN
Middle Name:PUDUNAGAR
Last Name:SUBBIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:180 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2430
Mailing Address - Country:US
Mailing Address - Phone:336-527-7000
Mailing Address - Fax:336-526-6056
Practice Address - Street 1:180 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2430
Practice Address - Country:US
Practice Address - Phone:336-527-7000
Practice Address - Fax:336-526-6056
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5634780OtherFIRST HEALTH
NC2513533OtherUNITED HEALTHCARE
NCD8290OtherMEDCOST
NC7942627OtherAETNA
NC1337JOtherBCBS OF NC
NC891377JMedicaid
NC9201803OtherCIGNA
NC2033176Medicare PIN
NC2513533OtherUNITED HEALTHCARE