Provider Demographics
NPI:1699807156
Name:THIRUMLAI, PRIYA S (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:S
Last Name:THIRUMLAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7927 INNKEEPER DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1460
Mailing Address - Country:US
Mailing Address - Phone:904-228-8738
Mailing Address - Fax:904-228-8738
Practice Address - Street 1:7927 INNKEEPER DR
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1460
Practice Address - Country:US
Practice Address - Phone:904-228-8738
Practice Address - Fax:904-228-8738
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99454207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279134001Medicaid
FLAG518ZMedicare PIN