Provider Demographics
NPI:1497094726
Name:V TIRUCHELVAM LLC
Entity Type:Organization
Organization Name:V TIRUCHELVAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VASUDEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRUCHELVAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-801-1250
Mailing Address - Street 1:2350 FREEDOM WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8200
Mailing Address - Country:US
Mailing Address - Phone:717-801-1250
Mailing Address - Fax:717-741-3031
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-801-1250
Practice Address - Fax:717-741-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033513E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA155518Medicare PIN