Healthcare Provider Details

I. General information

NPI: 1609566793
Provider Name (Legal Business Name): T. SUBRAMANIAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 TUSCANY DR
TRINITY FL
34655-7073
US

IV. Provider business mailing address

1226 TUSCANY DR
TRINITY FL
34655-7073
US

V. Phone/Fax

Practice location:
  • Phone: 727-423-6463
  • Fax: 727-375-2683
Mailing address:
  • Phone: 727-423-6463
  • Fax: 727-375-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier118987600
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name: DR. THONDIKULAM A SUBRAMANIAN
Title or Position: OWNER
Credential: MD
Phone: 727-423-6463