Provider Demographics
NPI:1194739995
Name:SUBRAMONY, SANKARASUBRAMONEY H (MD)
Entity type:Individual
Prefix:
First Name:SANKARASUBRAMONEY
Middle Name:H
Last Name:SUBRAMONY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-5550
Mailing Address - Fax:352-265-5575
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-5550
Practice Address - Fax:352-265-5575
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS088702084N0400X
FLME1049272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00432031OtherRR MCR PTAN
FL001537800Medicaid
MS0017726Medicaid
MS0017726Medicaid
MS0017726Medicaid
TX8J8005Medicare PIN
FL001537800Medicaid
MSD00814Medicare UPIN