MEDICARE: BABU SUBRAMANIAM MD

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	207T00000X	Neurological Surgery Physician	1216	VI
2	2084N0400X	Neurology Physician	2012-02068	NC
3	2084N0400X	Neurology Physician	101050	WI
4	2084N0400X	Neurology Physician	91046	SC

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

General Provider Information

NPI Number	:	1306808258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABU SUBRAMANIAM MD

Provider Business Mailing Address
First Line	:	300 SINGLETON RIDGE RD
Second Line	:	ATTENTION PNS CREDENTIALING
City	:	CONWAY
State	:	SC
Zip	:	29526-9142
Country	:	US
Telephone Number	:	843-234-6946
Fax Number	:

Provider Business Practice Location Address
First Line	:	8024 MYRTLE TRACE DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-8945
Country	:	US
Telephone Number	:	843-234-8950
Fax Number	:	843-234-8951

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

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/17/2024

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Directions to “ BABU SUBRAMANIAM MD” Practice Location

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