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General NPI Number Information
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NPI Number | 1225034010
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Entity Type | Individual
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Provider Name | SUBRAMANIAM BALACHANDRAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2005
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 1007 S WILLIAM ST
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City | ATLANTA
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State | TX
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Zip | 75551-3245
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Country | US
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Telephone | 903-799-3326
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 797
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City | LANCASTER
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State | TX
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Zip | 75146-0797
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Country | US
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Telephone | 254-694-5092
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Fax | 254-694-7039
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G0656
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License Number State | TX
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