Provider Demographics
NPI:1306827936
Name:JEEVAN, THIRUMALAIRAJ (MD)
Entity Type:Individual
Prefix:
First Name:THIRUMALAIRAJ
Middle Name:
Last Name:JEEVAN
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 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-1133
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 308
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-760-5510
Practice Address - Fax:410-760-5925
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45707207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACE8614 290010022OtherRAILROAD MEDICARE
MDKA95MA 54586701OtherCAREFIRST
DC3340 0003OtherCAREFIRST
MD462971000 206311500Medicaid
MDKA95MA 54586701OtherCAREFIRST
MDF51842Medicare UPIN