Provider Demographics
NPI:1255612768
Name:MAYILVAGANAN, BARANI SUBRAMANIAM (MD)
Entity type:Individual
Prefix:DR
First Name:BARANI
Middle Name:SUBRAMANIAM
Last Name:MAYILVAGANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BARANI
Other - Middle Name:SUBRAMANIAM
Other - Last Name:MAYILVAGANAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:BERKSHIRE MEDICAL CENTER
Mailing Address - Street 2:725 NORTH STREET
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-395-7655
Mailing Address - Fax:484-337-4082
Practice Address - Street 1:6400 FANNIN ST STE 1400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1512
Practice Address - Country:US
Practice Address - Phone:713-704-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA270366207RG0100X
TXR4277207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology