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General NPI Number Information
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NPI Number | 1932376738
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Entity Type | Individual
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Provider Name | SAMPATH SUBRAMANIAM M.D
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Gender | Male
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 1658 CHAMPLIN AVE STE 335
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City | UTICA
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State | NY
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Zip | 13502-4830
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Country | US
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Telephone | 315-624-4090
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Fax | 315-624-4095
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Provider Business Mailing Address
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Address Line | 111 HOSPITAL DR
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City | UTICA
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State | NY
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Zip | 13502-2517
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Country | US
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Telephone | 315-917-9966
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Fax | 731-660-2570
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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 | 051492
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 273432
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 55532
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License Number State | TN
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