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General NPI Number Information
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NPI Number | 1164786265
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Entity Type | Organization
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Legal Business Name | DR . SUBA VINAYAKOM MD LLC
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 19517 DOCTORS DR
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City | GERMANTOWN
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State | MD
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Zip | 20874-5247
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Country | US
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Telephone | 301-353-8700
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Fax | 301-353-0394
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Provider Business Mailing Address
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Address Line | 19517 DOCTORS DR
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City | GERMANTOWN
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State | MD
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Zip | 20874-5247
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Country | US
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Telephone | 301-353-8700
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Fax | 301-353-0394
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Authorized Official
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Title or Position | PHYSICIN
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Name | DR. SUBA VINAYAKOM
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Credential | MD
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Telephone | 301-353-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D25882
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License Number State | MD
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