MEDICARE: DR. SWAMINATHAN THANGARAJ D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	H0089319	MD
2	2084P0800X	Psychiatry Physician	OT016640	PA
3	2084P0804X	Child & Adolescent Psychiatry Physician	288367	MA

General Provider Information

NPI Number	:	1023499571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SWAMINATHAN THANGARAJ D.O

Provider Business Mailing Address
First Line	:	PO BOX 1340
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-1340
Country	:	US
Telephone Number	:	617-383-4082
Fax Number	:	617-540-5120

Provider Business Practice Location Address
First Line	:	1119 E WEST HWY
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4852
Country	:	US
Telephone Number	:	202-360-4787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2015
Last Update Date	:	03/20/2024

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