Healthcare Provider Details

I. General information

NPI: 1629021530
Provider Name (Legal Business Name): V. BALA SUBRAMANIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 DUKE ST
ALEXANDRIA VA
22304-2415
US

IV. Provider business mailing address

4915 AUBURN AVE SUITE 200
BETHESDA MD
20814-2636
US

V. Phone/Fax

Practice location:
  • Phone: 703-461-3556
  • Fax: 703-461-8075
Mailing address:
  • Phone: 301-907-3939
  • Fax: 301-656-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101229647
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: