Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 036091120 | IL |
NPI | 1134279177 |
---|---|
Provider Name | Ramamoorthy Nagasubramanian |
First Address | Rockland, DE 19732-0191 |
Second Address | Orlando, FL 32806-2944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 21/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036091120 | (05) | IL |