Basic Information
| Provider Information | |||||||||
| NPI: | 1821282849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUBRAMANIAN | ||||||||
| FirstName: | VAIRAVAN | ||||||||
| MiddleName: | SARAVANAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 GASTON AVE STE 1205 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752461812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146928262 | ||||||||
| FaxNumber: | 2146964190 | ||||||||
| Practice Location | |||||||||
| Address1: | 4708 ALLIANCE BLVD | ||||||||
| Address2: | STE 685 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725667765 | ||||||||
| FaxNumber: | 4694679437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2007 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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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 | 208800000X | N8994 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 663120 | 01 | TX | MEDICARE | OTHER |