Provider Demographics
NPI:1609017946
Name:RATHNASABAPATHY, CHENTHILMURUGAN (MBBS)
Entity Type:Individual
Prefix:
First Name:CHENTHILMURUGAN
Middle Name:
Last Name:RATHNASABAPATHY
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13041 N DEL WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3034
Mailing Address - Country:US
Mailing Address - Phone:623-832-0300
Mailing Address - Fax:623-285-2801
Practice Address - Street 1:13041 N DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3034
Practice Address - Country:US
Practice Address - Phone:623-832-0300
Practice Address - Fax:623-285-2801
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250433207R00000X
OH35095975207RH0003X
MI4301097497207RH0003X
AZ49144207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ905235Medicaid
OH3089143Medicaid
AZ49144OtherLICENSE
OHP00934600OtherRRMC
MIMI3764004Medicare PIN
AZ49144OtherLICENSE