Provider Demographics
NPI:1386689677
Name:THIAGARAJAH, MAHESH CANDIAH (MD)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:CANDIAH
Last Name:THIAGARAJAH
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 1:5555 E MOCKINGBIRD LN
Mailing Address - Street 2:1108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5364
Mailing Address - Country:US
Mailing Address - Phone:214-217-1911
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3629
Practice Address - Country:US
Practice Address - Phone:972-420-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9928207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174068002Medicaid
TX174068004Medicaid
TXP00364150OtherRAILROAD
TX174068003Medicaid
TX8W0730OtherBCBS
TX8W1782OtherBCBS
TX8G9117Medicare PIN
TX8J1214Medicare PIN
TX174068004Medicaid
TX174068003Medicaid