Provider Demographics
NPI:1588732036
Name:SUBBARATNAM, HEMALATHA (MD)
Entity type:Individual
Prefix:DR
First Name:HEMALATHA
Middle Name:
Last Name:SUBBARATNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEMA
Other - Middle Name:
Other - Last Name:SUBBARATNAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1253
Mailing Address - Fax:360-729-3185
Practice Address - Street 1:3311 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-222-5144
Practice Address - Fax:541-338-1070
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000457962081P0004X, 2084N0400X
CAC515532084N0400X
ND101112084N0400X
NV56402084N0400X
ORMD1894092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C515530Medicaid
CA00C515530Medicaid