Provider Demographics
NPI:1841203783
Name:THIAGARAJAN, RAMU (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMU
Middle Name:
Last Name:THIAGARAJAN
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 1:382 N. PEARSON DR.
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3368
Mailing Address - Country:US
Mailing Address - Phone:559-783-0100
Mailing Address - Fax:559-783-0200
Practice Address - Street 1:382 NORTH PEARSON DRIVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3368
Practice Address - Country:US
Practice Address - Phone:559-783-0100
Practice Address - Fax:559-783-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA955022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ69517ZOtherBLUE SHIELD GROUP PIN
CA00A955020OtherBLUE SHIELD PIN
CAZZZ05543ZOtherMEDICARE GROUP PTAN
CA00A955020Medicaid
CA00A955020Medicaid