Individual
CHARULOCHANA SUBRAMONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1530
(601) 984-1531
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1530
(601) 984-1531
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
09214
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00019365
—
MS
05
—
108644
—
MS
05
—
1304000
—
LA
01
—
220011385
RR MEDICARE
MS
01
—
P01271433
RAILROAD MEDICARE
MS
Enumeration date
07/06/2006
Last updated
03/21/2014
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