Provider Demographics
NPI:1003854282
Name:THUKKARAM, KAVITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:THUKKARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2290
Mailing Address - Country:US
Mailing Address - Phone:732-632-1700
Mailing Address - Fax:732-632-1704
Practice Address - Street 1:212 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2290
Practice Address - Country:US
Practice Address - Phone:732-632-1700
Practice Address - Fax:732-632-1704
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0005681Medicaid
NJ056881Medicare ID - Type Unspecified
NJ056881Medicare PIN
NJ0005681Medicaid