Basic Information
| Provider Information | |||||||||
| NPI: | 1013906858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUBRAMANIAN | ||||||||
| FirstName: | VINODHINI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 723 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130300723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152880317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 736 IRVING AVE | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154707111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD18338 | ME | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 239999 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A82592 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | EL91030 | ME | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD18338 | ME | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 285927 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 239999 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 39485714 | 05 | CO | MEDICAID | 46871837 | 05 | NM | MEDICAID | 913170 | 05 | AZ | MEDICAID |