Healthcare Provider Details

I. General information

NPI: 1306827936
Provider Name (Legal Business Name): THIRUMALAIRAJ JEEVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CRAIN HWY S SUITE 308
GLEN BURNIE MD
21061-5577
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-5510
  • Fax: 410-760-5925
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD45707
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD45707
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: