Provider Demographics
NPI:1972705457
Name:BALASUBRAMANIAN, VIDHYA (MD)
Entity type:Individual
Prefix:
First Name:VIDHYA
Middle Name:
Last Name:BALASUBRAMANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIDHYA
Other - Middle Name:
Other - Last Name:BALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:411 30TH ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3310
Mailing Address - Country:US
Mailing Address - Phone:510-841-0689
Mailing Address - Fax:510-841-8119
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:SUITE 314
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3310
Practice Address - Country:US
Practice Address - Phone:510-465-6800
Practice Address - Fax:510-268-0634
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108315207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine