Provider Demographics
NPI:1124213442
Name:VENKATACHALAM, THILAGAVATHI (MD)
Entity Type:Individual
Prefix:
First Name:THILAGAVATHI
Middle Name:
Last Name:VENKATACHALAM
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 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5499
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5499
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9160207RN0300X
NMFELMD2021-059207RN0300X, 207RN0300X
AZ69779207RN0300X
NJ25MA08293000207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0159182Medicaid
TX391103402OtherCSHCN
PAMD432657OtherPA MEDICAL LICENSE
TX391103401Medicaid
NJ60038240OtherHORIZON-NJ HEALTH
NJ2826013OtherUNITED HEALTHCARE
3423571000OtherAMERIHEALTH, KEYSTONE, IBC
NJ3K7722OtherHEALTHNET, INC
PA037276OtherMEDICARE AA #
NJ1636597OtherAETNA US HEALTHCARE
NJ7459570OtherCIGNA HEALTH CARE
NJMA082930OtherMEDICAL LICENSE
NJ01004600700OtherAMERICHOICE
NJP3853542OtherOXFORD HEALTH PLAN
NJP3853542OtherOXFORD HEALTH PLAN