Healthcare Provider Details

I. General information

NPI: 1396058533
Provider Name (Legal Business Name): SUBRAMANIAN GNANAGURUPARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 STANTON CHRISTIANA RD STE 203
NEWARK DE
19713-2130
US

IV. Provider business mailing address

620 STANTON CHRISTIANA RD STE 203
NEWARK DE
19713-2130
US

V. Phone/Fax

Practice location:
  • Phone: 302-338-9444
  • Fax: 302-994-9449
Mailing address:
  • Phone: 302-338-9444
  • Fax: 302-994-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number284558
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0010444
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC1-0010444
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: