Provider Demographics
NPI:1154639839
Name:THIAGARAJAN, SARAVANAN (MD)
Entity Type:Individual
Prefix:
First Name:SARAVANAN
Middle Name:
Last Name:THIAGARAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SARAVANAN
Other - Middle Name:
Other - Last Name:THIAGARAJAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9001 SUMMA AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3726
Mailing Address - Country:US
Mailing Address - Phone:225-761-5200
Mailing Address - Fax:225-761-5558
Practice Address - Street 1:9001 SUMMA AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3726
Practice Address - Country:US
Practice Address - Phone:225-761-5200
Practice Address - Fax:225-761-5558
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.207573207RR0500X
OH35.121055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03379578Medicaid
LA2398130Medicaid
MS03379578Medicaid