Provider Demographics
NPI:1386681112
Name:MADHAVAN, THIRUMALAI V (MD)
Entity Type:Individual
Prefix:
First Name:THIRUMALAI
Middle Name:V
Last Name:MADHAVAN
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 1:11 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1042
Mailing Address - Country:US
Mailing Address - Phone:908-753-9391
Mailing Address - Fax:
Practice Address - Street 1:695 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9302
Practice Address - Country:US
Practice Address - Phone:908-688-6565
Practice Address - Fax:908-686-6693
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ34297207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology