Healthcare Provider Details

I. General information

NPI: 1962579136
Provider Name (Legal Business Name): N THANNOLI PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 THANNOLI DR
SOMERSET KY
42503
US

IV. Provider business mailing address

55 THANNOLI DR
SOMERSET KY
42503
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-0854
  • Fax: 606-677-9311
Mailing address:
  • Phone: 606-677-0854
  • Fax: 606-677-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. NATARAJAN THANNOLI
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 606-677-0854