Provider Demographics
NPI:1851316442
Name:YOGANATHAN, THIL (MD)
Entity Type:Individual
Prefix:DR
First Name:THIL
Middle Name:
Last Name:YOGANATHAN
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 1:703 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503
Mailing Address - Country:US
Mailing Address - Phone:973-754-2320
Mailing Address - Fax:973-754-2381
Practice Address - Street 1:703 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503
Practice Address - Country:US
Practice Address - Phone:973-754-2320
Practice Address - Fax:973-754-2381
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03694800207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ10984OtherAMERIGROUP AMERICAID
NJ3124100Medicaid
NJPS266OtherOXFORD HEALTH
NJ0805704OtherAETNA
NJPS266OtherOXFORD HEALTH
NJ0805704OtherAETNA