Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 056774 | GA |
N | 208600000X | Surgeon | 056774 | GA |
N | 2086S0102X | Surgical Critical Care | 056774 | GA |
Y | 2086S0102X | Surgical Critical Care | ME132261 | FL |
NPI | 1073726469 |
---|---|
Provider Name | Dr. Anuradha Subramanian |
First Address | Fort Pierce, FL 34950-4838 |
Second Address | Fort Pierce, FL 34950-4838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 01/12/2020 |