Healthcare Provider Details

I. General information

NPI: 1588732036
Provider Name (Legal Business Name): HEMALATHA SUBBARATNAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEMA SUBBARATNAM M.D.

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 RIVERBEND DR
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-8004
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-5144
  • Fax: 541-338-1070
Mailing address:
  • Phone: 360-729-1253
  • Fax: 360-729-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberMD00045796
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD00045796
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC51553
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number10111
License Number StateND
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5640
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD189409
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: