Provider Demographics
NPI:1588864441
Name:SUBRAMANIAM, DEEPA S (MD)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:S
Last Name:SUBRAMANIAM
Suffix:
Gender:F
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 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR ROAD NW
Practice Address - Street 2:PODIUM B LOMBARDI
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-444-2198
Practice Address - Fax:202-444-2886
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00616349OtherRAILROAD MEDICARE
DC038891700Medicaid
VA1588864441Medicaid
VA1588864441Medicaid