Provider Demographics
NPI:1043274459
Name:SUBRAMANYAM, NANJUNDA SWAMY (MD)
Entity type:Individual
Prefix:
First Name:NANJUNDA
Middle Name:SWAMY
Last Name:SUBRAMANYAM
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 1:2517 SUN REEF RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6880
Mailing Address - Country:US
Mailing Address - Phone:702-363-5392
Mailing Address - Fax:702-233-5860
Practice Address - Street 1:2031 N BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0269
Practice Address - Country:US
Practice Address - Phone:702-383-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE29413Medicare UPIN