Provider Demographics
NPI:1558792226
Name:MYLAPPAN SELVARAJ, M.D.
Entity Type:Organization
Organization Name:MYLAPPAN SELVARAJ, M.D.
Other - Org Name:MYLAPPAN SELVARAJ, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HILDERBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-545-9774
Mailing Address - Street 1:600 MEDICAL ARTS BLDG STE 670
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7110
Mailing Address - Country:US
Mailing Address - Phone:724-545-9766
Mailing Address - Fax:724-543-2945
Practice Address - Street 1:600 MEDICAL ARTS BLDG STE 670
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7110
Practice Address - Country:US
Practice Address - Phone:724-545-9766
Practice Address - Fax:724-543-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA028840E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1091654Medicaid
PA1091654Medicaid