Provider Demographics
NPI:1811079262
Name:RAMACHANDRAN, SUBBAYAH THAMBAYAH (MD)
Entity type:Individual
Prefix:
First Name:SUBBAYAH
Middle Name:THAMBAYAH
Last Name:RAMACHANDRAN
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 1:3555 STAGG DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4509
Mailing Address - Country:US
Mailing Address - Phone:409-212-5922
Mailing Address - Fax:409-212-5951
Practice Address - Street 1:3555 STAGG DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4509
Practice Address - Country:US
Practice Address - Phone:409-212-5922
Practice Address - Fax:409-212-5951
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD48338Medicare UPIN
00J17YMedicare ID - Type Unspecified