Individual
VISAHARAN SIVASUBRAMANIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
207 FOOTE AVE, JAMESTOWN, NY 14701-7077
(716) 487-0141
Mailing address
207 FOOTE AVE, JAMESTOWN, NY 14701-7077
(716) 487-0141
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
310496
NY
207RH0003X
Hematology & Oncology Physician
Primary
310496
NY
207RH0003X
Hematology & Oncology Physician
38197
KY
207RX0202X
Medical Oncology Physician
310496
NY
207RX0202X
Medical Oncology Physician
38197
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000325000
BLUE CROSS BLUE SHEILD
KY
05
—
64071939
—
KY
01
—
P00107535
RAILROAD MEDICARE
KY
Enumeration date
06/16/2005
Last updated
06/21/2024
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