MEDICARE: P.S. SUBRAMANIAM, MD, PC

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	2084N0400X	Neurology Physician	0101041206	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1013910652	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1164639001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P.S. SUBRAMANIAM, MD, PC

Provider Business Mailing Address
First Line	:	620 WALSING DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-8133
Country	:	US
Telephone Number	:	804-520-1157
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1418
Country	:	US
Telephone Number	:	804-520-1157
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. POOVILLAM S SUBRAMANIAM
Credential	:	M.D.
Telephone Number	:	804-520-1157

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/30/2008

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