MEDICARE: DR. MYLAPPAN SELVARAJ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD-028840-E	PA
2	207RC0000X	Cardiovascular Disease Physician	42361	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SE127889	OTHER	PA	BG & BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164427183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYLAPPAN SELVARAJ M.D.

Provider Business Mailing Address
First Line	:	109 WINTERWOOD DR
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-2833
Country	:	US
Telephone Number	:	724-679-4192
Fax Number	:	724-482-1162

Provider Business Practice Location Address
First Line	:	777 NORTH ST
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-4147
Country	:	US
Telephone Number	:	724-545-9774
Fax Number	:	724-543-2945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/23/2020

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