Individual provider · NPI-1

Manjula Balasubramanian, MD

Pathology, Anatomic Pathology & Clinical Pathology · Philadelphia, PA

NPI number1336191683
StatusActive
Last updated in NPPESDec 31, 2019

Details

NPI
1336191683
Entity type
Individual (NPI-1)
Name
Manjula Balasubramanian
Credential
MD
Sex
Female
Sole proprietor
No
Enumeration date
May 16, 2006
Certification date
Dec 31, 2019
Last updated
Dec 31, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207ZP0102X Pathology, Anatomic Pathology & Clinical PathologyMD032700EPAYes
207ZP0105X Pathology, Clinical Pathology/Laboratory MedicineMD032700EPA

Practice location

245 N 15th St
Ms 435
Philadelphia, PA 19102-1101

Phone 215-762-8873 · Fax 215-762-3274

Mailing address

101 E Olney Ave
Ste 400
Philadelphia, PA 19120-2470

Phone 215-255-7822 · Fax 215-255-7825

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