Provider Demographics
NPI:1588744429
Name:SUBRAMANIAN, DEEPA (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-5535
Mailing Address - Country:US
Mailing Address - Phone:727-942-3355
Mailing Address - Fax:877-902-4052
Practice Address - Street 1:1812 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5535
Practice Address - Country:US
Practice Address - Phone:727-942-3355
Practice Address - Fax:877-902-4052
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013844700Medicaid
FL013844700Medicaid