Organization
COASTAL GASTROENTEROLOGY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KALYANAM SUBRAMANYAM M.D. (PRESIDENT)
(281) 557-2527
Entity
Organization
Contact information
Practice address
1015 MEDICAL CENTER BLVD, SUITE 1300, WEBSTER, TX 77598-4052
(281) 557-2527
(281) 557-7203
Mailing address
1015 MEDICAL CENTER BLVD, SUITE 1300, WEBSTER, TX 77598-4052
(281) 557-2527
(281) 557-7203
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114758902
THMP - DR. SUBRAMANYAM
TX
01
—
1164493870
NPI - INDIVIDUAL
—
01
—
2226780
BCBS - TX - BLUE LINK ID
TX
01
—
4102895
AETNA
—
01
—
5283
RR MCR GROUP NUMBER
—
01
—
B26780
MCR UPIN - INDIVIDUAL
—
01
—
P00440059
RR MCR
—
Enumeration date
09/03/2006
Last updated
06/02/2014
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