=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700328499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIYA SUBRAMANIAN MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2016
-----------------------------------------------------
Last Update Date | 12/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 HOSPITAL PKWY STE 200
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76022-5935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-916-8877
-----------------------------------------------------
Fax | 817-527-2969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1615 HOSPITAL PKWY STE 200
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76022-5935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-916-8877
-----------------------------------------------------
Fax | 817-527-2969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OBULAKSHMIPRIYA SUBRAMANIAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 817-916-8877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | N2436
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------