Healthcare Provider Details

I. General information

NPI: 1235160540
Provider Name (Legal Business Name): NATESA PANDIAN SHANMUGAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GREENBELT RD SUITE 101
LANHAM MD
20706-2273
US

IV. Provider business mailing address

12204 SELINE WAY
POTOMAC MD
20854-2872
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-6666
  • Fax:
Mailing address:
  • Phone: 202-468-3303
  • Fax: 301-762-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0050412
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD21776
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: