Individual
DR. POOVILLAM S SUBRAMANIAM-MOOTHATHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FAAN, FAHA, CIME
Contact information
Practice address
3400 BOULEVARD, COLONIAL HEIGHTS, VA 23834-1418
(804) 741-6484
Mailing address
620 WALSING DR, RICHMOND, VA 23229-8133
(804) 741-6484
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
0101041206
VA
Other
Enumeration date
05/27/2005
Last updated
08/10/2011
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