Provider Demographics
NPI:1932376738
Name:SUBRAMANIAM, SAMPATH (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMPATH
Middle Name:
Last Name:SUBRAMANIAM
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 1:379 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2080
Mailing Address - Country:US
Mailing Address - Phone:731-984-7005
Mailing Address - Fax:731-660-2570
Practice Address - Street 1:379 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2080
Practice Address - Country:US
Practice Address - Phone:731-984-7005
Practice Address - Fax:731-660-2570
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051492208600000X
NY273432208600000X
TN55532208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery