MEDICARE: BALACHUNDHAR SUBRAMANIAM M.B.B.S, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	216718	MA

General Provider Information

NPI Number	:	1073574174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALACHUNDHAR SUBRAMANIAM M.B.B.S, M.D.

Provider Business Mailing Address
First Line	:	22 PROSPECT HILL RD
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-6910
Country	:	US
Telephone Number	:	617-754-2675
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 PROSPECT HILL RD
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02421-6910
Country	:	US
Telephone Number	:	617-754-2675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	09/13/2007

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