Provider Demographics
NPI:1083821375
Name:THIRU MD, PA
Entity Type:Organization
Organization Name:THIRU MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VALLUR
Authorized Official - Middle Name:
Authorized Official - Last Name:THIRUMAVALAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-322-7632
Mailing Address - Street 1:4 PRINCESS RD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2322
Mailing Address - Country:US
Mailing Address - Phone:609-243-0045
Mailing Address - Fax:609-844-1092
Practice Address - Street 1:1323 HWY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-322-7632
Practice Address - Fax:732-302-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097164Medicare ID - Type Unspecified