Individual
VIDYA SUBRAMANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1010 SPRUCE ST, ESPANOLA MULTI-SPECIALTY CLINIC, ESPANOLA, NM 87532
(505) 367-0340
(505) 367-0346
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2005-0040
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3186831
—
NM
Enumeration date
03/22/2007
Last updated
08/15/2008
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