Provider Demographics
NPI:1639286073
Name:GANESAN, MURUGESAPILLAI (MD)
Entity Type:Individual
Prefix:DR
First Name:MURUGESAPILLAI
Middle Name:
Last Name:GANESAN
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 1:680 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-878-8332
Mailing Address - Fax:203-876-0494
Practice Address - Street 1:680 BOSTON POST RD
Practice Address - Street 2:MEDICAL GROUP OF MILFORD
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2686
Practice Address - Country:US
Practice Address - Phone:203-878-8332
Practice Address - Fax:203-876-0494
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17201207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B84013Medicare UPIN
110007302Medicare ID - Type Unspecified