Provider Demographics
NPI:1033436530
Name:MUNIRAJ, THIRUVENGADAM (MD PHD FRCP (LONDON))
Entity Type:Individual
Prefix:DR
First Name:THIRUVENGADAM
Middle Name:
Last Name:MUNIRAJ
Suffix:
Gender:M
Credentials:MD PHD FRCP (LONDON)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 YORK ST, STE LMP 1080
Mailing Address - Street 2:DEPARTMENT OF MEDICINE (DIGESTIVE DISEASES)
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-200-5083
Mailing Address - Fax:
Practice Address - Street 1:35 PARK ST
Practice Address - Street 2:YALE NEW HAVEN HOSPITAL, SMILOW CANCER CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-200-5083
Practice Address - Fax:203-200-2235
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50095207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1033436530Medicaid