Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD022633E | PA |
NPI | 1023008471 |
---|---|
Provider Name | Easwaran Balasubramanian |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 09/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010434410001 | (05) | PA |
B41747 | (02) |