Healthcare Provider Details

I. General information

NPI: 1295941425
Provider Name (Legal Business Name): SUCHARITHA SHANMUGAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 W LINCOLN HWY
EXTON PA
19341-2547
US

IV. Provider business mailing address

780 W LINCOLN HWY
EXTON PA
19341-2547
US

V. Phone/Fax

Practice location:
  • Phone: 484-206-4447
  • Fax: 484-237-9565
Mailing address:
  • Phone: 484-206-4447
  • Fax: 484-237-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD426764
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT178938
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: