Provider Demographics
NPI:1285834812
Name:PUGAZHENDHI, THIRIPURASUNDARI (MD)
Entity Type:Individual
Prefix:
First Name:THIRIPURASUNDARI
Middle Name:
Last Name:PUGAZHENDHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THIRIPURASUNDARI
Other - Middle Name:
Other - Last Name:PUGAZHENDHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5530 N VIA UMBROSA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6462
Mailing Address - Country:US
Mailing Address - Phone:520-296-4690
Mailing Address - Fax:520-300-4991
Practice Address - Street 1:3600 S 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-5154
Practice Address - Country:US
Practice Address - Phone:520-629-4606
Practice Address - Fax:520-838-3656
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46811207WX0009X, 207W00000X
OH35122100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ930958Medicaid
AZZ 171853OtherMEDICARE