Individual
BALAMURALI BALASUBRAMANIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-4017
Mailing address
100 COLD SPRING RD APT 215, ROCKY HILL, CT 06067-3129
(954) 263-6809
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
P1725
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831350446
TRICARE - SOUTH
TX
05
—
297419801
—
TX
01
—
8DC790
BCBS-TX
TX
01
—
P1725
STATE LICENSE
TX
Enumeration date
06/17/2008
Last updated
11/26/2012
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