Individual
DR. AMBALAVANAN BALASUBRAMANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5311 OLD COURT RD, RANDALLSTOWN, MD 21133-5241
(410) 922-7382
(410) 922-7384
Mailing address
5311 OLD COURT RD, RANDALLSTOWN, MD 21133-5241
(410) 922-7382
(410) 922-7384
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D65046
MD
Other
Enumeration date
11/23/2006
Last updated
08/27/2010
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