Provider Demographics
NPI:1083635353
Name:ANNASWAMY, THIRU MANDYAM (MD, MA)
Entity Type:Individual
Prefix:DR
First Name:THIRU
Middle Name:MANDYAM
Last Name:ANNASWAMY
Suffix:
Gender:M
Credentials:MD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0850
Mailing Address - Country:US
Mailing Address - Phone:717-531-4263
Mailing Address - Fax:717-566-8202
Practice Address - Street 1:1135 OLDE W CHOCOLATE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9188
Practice Address - Country:US
Practice Address - Phone:717-531-7010
Practice Address - Fax:717-531-7102
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD477514204R00000X, 2081N0008X, 208VP0000X, 208100000X
TXK7977208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG98261Medicare UPIN