Provider Demographics
NPI:1528321767
Name:BALASUBRAMANIAM, SARANYA C (MD)
Entity type:Individual
Prefix:
First Name:SARANYA
Middle Name:C
Last Name:BALASUBRAMANIAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1559 MARION RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6332
Mailing Address - Country:US
Mailing Address - Phone:909-881-3032
Mailing Address - Fax:909-881-0668
Practice Address - Street 1:7798 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4014
Practice Address - Country:US
Practice Address - Phone:909-445-8535
Practice Address - Fax:909-552-8955
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN56477207W00000X
CA143000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN180001619Medicare PIN