Provider Demographics
NPI:1609920859
Name:MUTHAPPAN, PALANIAPPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PALANIAPPAN
Middle Name:
Last Name:MUTHAPPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2731
Mailing Address - Country:US
Mailing Address - Phone:937-223-4461
Mailing Address - Fax:937-449-7603
Practice Address - Street 1:122 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2731
Practice Address - Country:US
Practice Address - Phone:937-223-4461
Practice Address - Fax:937-449-7603
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD166969207RC0000X, 207R00000X
OH35127819207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT1629OtherJOHNS HOPKINS PROVIDER ID
OH0164773Medicaid
OH0164773Medicaid