MEDICARE: ANNAMALAI MUTHIAH JR. MD

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	174400000X	Specialist	0101222615	VA
2	2085R0202X	Diagnostic Radiology Physician	D0062747	MD
3	2085R0202X	Diagnostic Radiology Physician	0101222615	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063407997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNAMALAI MUTHIAH JR. MD

Provider Business Mailing Address
First Line	:	110 KINGSLEY LN STE 305
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23505-4617
Country	:	US
Telephone Number	:	757-889-5422
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 KINGSLEY LN
Second Line	:	305
City	:	NORFOLK
State	:	VA
Zip	:	23505-4614
Country	:	US
Telephone Number	:	757-889-5422
Fax Number	:	757-889-5450

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	09/06/2022

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