Individual
EASWARAN BALASUBRAMANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-2111
(215) 707-2324
Mailing address
2450 W. HUNTING PARK AVENUE, PHILADELPHIA, PA 19129-1302
(215) 707-4739
(215) 707-3677
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD022633E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010434410001
—
PA
Enumeration date
10/26/2005
Last updated
02/09/2012
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