Healthcare Provider Details

I. General information

NPI: 1023499571
Provider Name (Legal Business Name): SWAMINATHAN THANGARAJ D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E WEST HWY
SILVER SPRING MD
20910-4852
US

IV. Provider business mailing address

PO BOX 1340
PEMBROKE MA
02359-1340
US

V. Phone/Fax

Practice location:
  • Phone: 202-360-4787
  • Fax:
Mailing address:
  • Phone: 617-383-4082
  • Fax: 617-540-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberH0089319
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOT016640
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number288367
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: