Healthcare Provider Details

I. General information

NPI: 1154370203
Provider Name (Legal Business Name): HAMSA N SUBRAMANIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N NEW BALLAS RD STE 203
SAINT LOUIS MO
63141-6814
US

IV. Provider business mailing address

425 N NEW BALLAS RD STE 203
SAINT LOUIS MO
63141-6814
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-3104
  • Fax: 314-994-7105
Mailing address:
  • Phone: 314-872-3104
  • Fax: 314-994-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number107809
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: