Provider Demographics
NPI:1568969624
Name:THIRUMARAN, REVATHI SANGEETHA
Entity Type:Individual
Prefix:MRS
First Name:REVATHI
Middle Name:SANGEETHA
Last Name:THIRUMARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REVASANG@GMAIL.COM
Mailing Address - Street 2:24 CHAMBERLAIN CT
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342
Mailing Address - Country:US
Mailing Address - Phone:516-717-9253
Mailing Address - Fax:
Practice Address - Street 1:24 CHAMBERLAIN CT
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342
Practice Address - Country:US
Practice Address - Phone:516-717-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA121509367500000X
PARN678507367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered