Provider Demographics
NPI:1548212350
Name:CHANDRASEKHAR, SUBRAMANIYAM (MD)
Entity type:Individual
Prefix:
First Name:SUBRAMANIYAM
Middle Name:
Last Name:CHANDRASEKHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-0244
Mailing Address - Country:US
Mailing Address - Phone:304-233-9314
Mailing Address - Fax:304-233-0265
Practice Address - Street 1:700 KEVIN DR
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2757
Practice Address - Country:US
Practice Address - Phone:304-455-5910
Practice Address - Fax:304-455-2870
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807689000Medicaid
OH2700152Medicaid
H41375Medicare UPIN
WV1807689000Medicaid