MEDICARE: DR. PADMA BALASUBRAMANIAN 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	151407	MA

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	:	1649233933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PADMA BALASUBRAMANIAN M.D.

Provider Business Mailing Address
First Line	:	111 CYPRESS ST
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02445-6002
Country	:	US
Telephone Number	:	857-307-0896
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 PATRIOT PL
Second Line	:
City	:	FOXBOROUGH
State	:	MA
Zip	:	02035-1375
Country	:	US
Telephone Number	:	508-718-4010
Fax Number	:	508-718-4011

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	07/06/2012

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