MEDICARE: DR. GEETHA SUBRAMANYAM 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	G6026	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2322391	OTHER	TX	BLUE LINK ID
2	0068LB	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487625794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEETHA SUBRAMANYAM M.D.

Provider Business Mailing Address
First Line	:	1015 MEDICAL CENTER BLVD
Second Line	:	SUITE 1300
City	:	WEBSTER
State	:	TX
Zip	:	77598-4052
Country	:	US
Telephone Number	:	281-557-2527
Fax Number	:	281-557-7203

Provider Business Practice Location Address
First Line	:	1015 MEDICAL CENTER BLVD
Second Line	:	SUITE 1300
City	:	WEBSTER
State	:	TX
Zip	:	77598-4052
Country	:	US
Telephone Number	:	281-557-2527
Fax Number	:	281-557-7203

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	02/28/2017

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