Basic Information
| Provider Information | |||||||||
| NPI: | 1255612768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYILVAGANAN | ||||||||
| FirstName: | BARANI | ||||||||
| MiddleName: | SUBRAMANIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAYILVAGANAN | ||||||||
| OtherFirstName: | BARANI | ||||||||
| OtherMiddleName: | SUBRAMANIAM | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | BERKSHIRE MEDICAL CENTER | ||||||||
| Address2: | 725 NORTH STREET | ||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133957655 | ||||||||
| FaxNumber: | 4843374082 | ||||||||
| Practice Location | |||||||||
| Address1: | BERKSHIRE MEDICAL CENTER | ||||||||
| Address2: | 725 NORTH STREET | ||||||||
| City: | PITTSFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133957655 | ||||||||
| FaxNumber: | 4134472667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2011 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 270366 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.