Provider Demographics
NPI:1164407383
Name:MUTHIAH, SETHURAMAN (MD)
Entity Type:Individual
Prefix:
First Name:SETHURAMAN
Middle Name:
Last Name:MUTHIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6977 RTE 611OLYMPIA PLAZA
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360
Mailing Address - Country:US
Mailing Address - Phone:570-424-2025
Mailing Address - Fax:570-424-2028
Practice Address - Street 1:6977 RTE 611 OLYMPIA PLAZA
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:570-424-2025
Practice Address - Fax:570-424-2028
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062949L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG57227Medicare ID - Type Unspecified
G57227Medicare UPIN