Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | M7667 | TX |
NPI | 1043476625 |
---|---|
Provider Name | Lalitha Subramanyam |
First Address | Irving, TX 75061-2222 |
Second Address | Irving, TX 75061-2222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2008 |
Last Update Date | 19/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210241001 | (05) | TX |
8BN460 | BCBSTX (01) | TX |