1962490698 NPI number — DR. AATHIRAYEN THIYAGARAJAH M.D.

Table of content: DR. AATHIRAYEN THIYAGARAJAH M.D. (NPI 1962490698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962490698 NPI number — DR. AATHIRAYEN THIYAGARAJAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIYAGARAJAH
Provider First Name:
AATHIRAYEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THIYAGA
Provider Other First Name:
AATHI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962490698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 BROAD ST
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SUMTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29150-4167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-373-7246
Provider Business Mailing Address Fax Number:
864-286-3077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2076 WOODRUFF RD
Provider Second Line Business Practice Location Address:
SPINE AND PAIN CARE
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-5939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-373-7246
Provider Business Practice Location Address Fax Number:
864-286-3077
Provider Enumeration Date:
10/06/2005

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: 174400000X , with the licence number:  23453 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 234534 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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