Provider Demographics
NPI:1942219563
Name:BALASUBRAMANIAN, GEETHA (MD)
Entity type:Individual
Prefix:DR
First Name:GEETHA
Middle Name:
Last Name:BALASUBRAMANIAN
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 1:1000 EDGEWATER PT STE 303
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2954
Mailing Address - Country:US
Mailing Address - Phone:636-265-2225
Mailing Address - Fax:636-265-0320
Practice Address - Street 1:1000 EDGEWATER PT STE 303
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2954
Practice Address - Country:US
Practice Address - Phone:636-265-2225
Practice Address - Fax:636-265-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008019340207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology