Provider Demographics
NPI:1841262201
Name:SUBRAMANIAN, LATHA (MD)
Entity type:Individual
Prefix:DR
First Name:LATHA
Middle Name:
Last Name:SUBRAMANIAN
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 1:4048 LAUREL ST
Mailing Address - Street 2:STE 305
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5391
Mailing Address - Country:US
Mailing Address - Phone:907-569-2627
Mailing Address - Fax:907-569-2626
Practice Address - Street 1:4048 LAUREL ST
Practice Address - Street 2:STE 305
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5391
Practice Address - Country:US
Practice Address - Phone:907-569-2627
Practice Address - Fax:907-569-2626
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA2285207RH0000X, 207RH0003X, 207RX0202X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAA2285OtherSTATE LICENSE
AKMD2285Medicaid
AKAS1890715OtherDEA
AKK151297Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
AKAA2285OtherSTATE LICENSE