Healthcare Provider Details

I. General information

NPI: 1083821375
Provider Name (Legal Business Name): THIRU MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 HWY 27
SOMERSET NJ
08873
US

IV. Provider business mailing address

4 PRINCESS RD SUITE #207
LAWRENCEVILLE NJ
08648-2322
US

V. Phone/Fax

Practice location:
  • Phone: 732-322-7632
  • Fax: 732-302-2429
Mailing address:
  • Phone: 609-243-0045
  • Fax: 609-844-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VALLUR THIRUMAVALAVAN
Title or Position: OFFICIAL
Credential: M.D.
Phone: 732-322-7632