Provider Demographics
NPI:1528229291
Name:THURGOOD, JEREMIAH LANG (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:LANG
Last Name:THURGOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:L
Other - Last Name:THURGOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:DEPT 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:317-567-2180
Mailing Address - Fax:317-567-2191
Practice Address - Street 1:1001 W 10TH ST
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2859
Practice Address - Country:US
Practice Address - Phone:317-630-7525
Practice Address - Fax:317-713-1261
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065305A207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000584772OtherANTHEM
IN248340ZMedicare PIN