Provider Demographics
NPI:1396058533
Name:GNANAGURUPARAN, SUBRAMANIAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUBRAMANIAN
Middle Name:
Last Name:GNANAGURUPARAN
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 1:620 STANTON CHRISTIANA RD STE 203
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2130
Mailing Address - Country:US
Mailing Address - Phone:302-338-9444
Mailing Address - Fax:302-994-9449
Practice Address - Street 1:620 STANTON CHRISTIANA RD STE 203
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2130
Practice Address - Country:US
Practice Address - Phone:302-338-9444
Practice Address - Fax:302-994-9449
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284558207R00000X
DEC1-0010444207R00000X, 207RC0000X
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1396058533Medicaid