Provider Demographics
NPI:1053847640
Name:SUBRAMANYAM, SANTOSH (MD)
Entity type:Individual
Prefix:
First Name:SANTOSH
Middle Name:
Last Name:SUBRAMANYAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4458 MEDICAL DR STE 505
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3748
Mailing Address - Country:US
Mailing Address - Phone:210-690-7400
Mailing Address - Fax:
Practice Address - Street 1:4458 MEDICAL DR STE 505
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3748
Practice Address - Country:US
Practice Address - Phone:210-690-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV1902207RC0200X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine