Healthcare Provider Details

I. General information

NPI: 1275856445
Provider Name (Legal Business Name): ARUNACHALAM THENAPPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

PO BOX 37215
BALTIMORE MD
21297-3215
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-8351
  • Fax:
Mailing address:
  • Phone: 202-476-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD039840
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number25MA10943000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD039840
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number25MA10943000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: