Provider Demographics
NPI:1912197443
Name:BALASUBRAMANYA, ARCHANA (MD)
Entity type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:BALASUBRAMANYA
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 1:500 NE MULTNOMAH ST FL 11
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2023
Mailing Address - Country:US
Mailing Address - Phone:503-499-5200
Mailing Address - Fax:503-499-5535
Practice Address - Street 1:3175 NE ALOCLEK DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7135
Practice Address - Country:US
Practice Address - Phone:503-499-5200
Practice Address - Fax:503-499-5535
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30576207R00000X
ORMD207404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000585Medicare PIN