Provider Demographics
NPI:1235160540
Name:SHANMUGAM, NATESA PANDIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NATESA
Middle Name:PANDIAN
Last Name:SHANMUGAM
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 1:12204 SELINE WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2872
Mailing Address - Country:US
Mailing Address - Phone:202-468-3303
Mailing Address - Fax:301-762-0408
Practice Address - Street 1:9801 GREENBELT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2273
Practice Address - Country:US
Practice Address - Phone:301-552-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050412207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6875-0043OtherCARE FIRST BLUE CROSS
MD110223746OtherUHC RAIL ROAD
MD746801600Medicaid
MD110223746OtherUHC RAIL ROAD
MDH01760Medicare UPIN
MD746801600Medicaid