Individual
MANJULA BALASUBRAMANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
245 N 15TH ST, MS 435, PHILADELPHIA, PA 19102-1101
(215) 762-8873
(215) 762-3274
Mailing address
101 E OLNEY AVE, STE 400, PHILADELPHIA, PA 19120-2470
(215) 255-7822
(215) 255-7825
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD032700E
PA
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
MD032700E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001248171
—
PA
Enumeration date
05/16/2006
Last updated
12/31/2019
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