Provider Demographics
NPI:1821012287
Name:THANGAVEL, MURUGESAMUDALI (MD,)
Entity Type:Individual
Prefix:DR
First Name:MURUGESAMUDALI
Middle Name:
Last Name:THANGAVEL
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:MURUGESAMUDALI
Other - Middle Name:
Other - Last Name:THANGAVEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:43741 SECURE PL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5861
Mailing Address - Country:US
Mailing Address - Phone:661-949-5366
Mailing Address - Fax:661-726-6251
Practice Address - Street 1:1600 W AVENUE J
Practice Address - Street 2:NEONATAL INTENSIVE CARE UNIT
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2814
Practice Address - Country:US
Practice Address - Phone:661-949-5373
Practice Address - Fax:661-726-6251
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA341172080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341170Medicaid