Provider Demographics
NPI:1346283009
Name:THIRUMAVALAVAN, VALLUR (MD)
Entity Type:Individual
Prefix:
First Name:VALLUR
Middle Name:
Last Name:THIRUMAVALAVAN
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 1:1553 HIGHWAY 27
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-301-2628
Mailing Address - Fax:732-377-3319
Practice Address - Street 1:1553 STATE ROUTE 27
Practice Address - Street 2:SUITE 2300
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3993
Practice Address - Country:US
Practice Address - Phone:732-301-2628
Practice Address - Fax:732-377-3319
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06653200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7723903Medicaid
NJ7723903Medicaid
NJ022393Medicare ID - Type Unspecified