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General NPI Number Information
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NPI Number | 1578905865
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Entity Type | Organization
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Legal Business Name | LUNG SPECIALIST OF WILLIAMSBURG PC
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Dates
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Enumeration Date | 07/27/2013
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 121 BULIFANTS BLVD SUITE A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5736
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Country | US
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Telephone | 757-707-3999
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Fax | 757-707-3993
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Provider Business Mailing Address
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Address Line | 121 BULIFANTS BLVD SUITE A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5736
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Country | US
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Telephone | 757-707-3999
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Fax | 757-707-3993
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIJAY SUBRAMANIAM
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Credential | MD
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Telephone | 757-707-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0101246032
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License Number State | VA
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