1033152111 NPI number — DR. KIONA R SUBRAMANIAN MD

Table of content: DR. KIONA R SUBRAMANIAN MD (NPI 1033152111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033152111 NPI number — DR. KIONA R SUBRAMANIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUBRAMANIAN
Provider First Name:
KIONA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033152111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6228 NW 43RD ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32653-8871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-332-6680
Provider Business Mailing Address Fax Number:
352-332-6604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6228 NW 43RD ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32653-8871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-332-6680
Provider Business Practice Location Address Fax Number:
352-332-6604
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101238177 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 306331 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: P00229852 . This is a "PALMETTO GBA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4132903 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 95535 . This is a "COMMUNITY HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0895051 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 179792 . This is a "ANTHEM SVC/HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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