Provider Demographics
NPI:1043476625
Name:SUBRAMANYAM, LALITHA (MD)
Entity type:Individual
Prefix:
First Name:LALITHA
Middle Name:
Last Name:SUBRAMANYAM
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 1:2021 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 515
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2222
Mailing Address - Country:US
Mailing Address - Phone:972-259-3282
Mailing Address - Fax:972-259-2033
Practice Address - Street 1:2021 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2222
Practice Address - Country:US
Practice Address - Phone:972-259-3282
Practice Address - Fax:972-259-2033
Is Sole Proprietor?:No
Enumeration Date:2008-08-02
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7667207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BN460OtherBCBSTX
TX210241001Medicaid
TX8BN460OtherBCBSTX
TXP01221152Medicare PIN