=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710270657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUBRA ANANDASIVAM MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2011
-----------------------------------------------------
Last Update Date | 05/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 S PRICE RD SUITE A
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78521-2459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-548-2242
-----------------------------------------------------
Fax | 956-548-2262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 64 S PRICE RD SUITE A
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78521-2459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-548-2242
-----------------------------------------------------
Fax | 956-548-2262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | SUBRA ANANDASIVAM
-----------------------------------------------------
Credential | MD PA
-----------------------------------------------------
Telephone | 956-548-2242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------