Healthcare Provider Details

I. General information

NPI: 1770661126
Provider Name (Legal Business Name): THIYAGARAJAN RAJU MEYAPPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 E 19TH AVE RMCH - PEDIATRIC INTENSIVE CARE UNIT - 3RD FLOOR
DENVER CO
80218-1235
US

IV. Provider business mailing address

1719 E 19TH AVE RMCH - PEDIATRIC INTENSIVE CARE UNIT - 3RD FLOOR
DENVER CO
80218-1235
US

V. Phone/Fax

Practice location:
  • Phone: 720-754-4300
  • Fax:
Mailing address:
  • Phone: 720-754-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberM4879
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number49969
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number238275-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: