Provider Demographics
NPI:1710640743
Name:KIRUBA, SHARUGASH
Entity Type:Individual
Prefix:
First Name:SHARUGASH
Middle Name:
Last Name:KIRUBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHARUGASH
Other - Middle Name:
Other - Last Name:SWARGALOGANATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5107 CROSSFIELD CT APT 10
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2142
Mailing Address - Country:US
Mailing Address - Phone:347-574-7034
Mailing Address - Fax:
Practice Address - Street 1:620 W LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1508
Practice Address - Country:US
Practice Address - Phone:347-574-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant