Healthcare Provider Details

I. General information

NPI: 1841262201
Provider Name (Legal Business Name): LATHA SUBRAMANIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 03/07/2023
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 LAUREL ST STE 305
ANCHORAGE AK
99508-5391
US

IV. Provider business mailing address

4048 LAUREL ST STE 305
ANCHORAGE AK
99508-5391
US

V. Phone/Fax

Practice location:
  • Phone: 907-569-2627
  • Fax: 907-569-2626
Mailing address:
  • Phone: 907-569-2627
  • Fax: 907-569-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberAA2285
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberAA2285
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberAA2285
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAA2285
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: