Provider Demographics
NPI:1477832517
Name:DEIVARAJU, CHENTHURAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHENTHURAN
Middle Name:
Last Name:DEIVARAJU
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 1:4351 E LOHMAN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8262
Mailing Address - Country:US
Mailing Address - Phone:575-532-9755
Mailing Address - Fax:575-532-8881
Practice Address - Street 1:4351 E LOHMAN AVE STE 301
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8262
Practice Address - Country:US
Practice Address - Phone:575-532-9755
Practice Address - Fax:575-532-8881
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60558-20207X00000X
FLME121046207X00000X
NMMD2014-0664207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47485817Medicaid
NM47485817Medicaid