1891040630 NPI number — THARENIE SIVARAJAH MD

Table of content: THARENIE SIVARAJAH MD (NPI 1891040630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891040630 NPI number — THARENIE SIVARAJAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIVARAJAH
Provider First Name:
THARENIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891040630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 EAST 17TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEYENNE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82001-4797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-632-2434
Provider Business Mailing Address Fax Number:
307-634-3510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 EAST 17TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82001-4797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-632-2434
Provider Business Practice Location Address Fax Number:
307-634-3510
Provider Enumeration Date:
07/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  293430 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 032-T2 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)