Healthcare Provider Details

I. General information

NPI: 1548212350
Provider Name (Legal Business Name): SUBRAMANIYAM CHANDRASEKHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KEVIN DR
NEW MARTINSVILLE WV
26155-2757
US

IV. Provider business mailing address

PO BOX 244
NEW MARTINSVILLE WV
26155-0244
US

V. Phone/Fax

Practice location:
  • Phone: 304-455-5910
  • Fax: 304-455-2870
Mailing address:
  • Phone: 304-233-9314
  • Fax: 304-233-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20461
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: