Provider Demographics
NPI:1851340392
Name:SUPPIAH, KATHIRESAN (MD)
Entity Type:Individual
Prefix:
First Name:KATHIRESAN
Middle Name:
Last Name:SUPPIAH
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 1:109 MERRY MET FARMS DR
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1697
Mailing Address - Country:US
Mailing Address - Phone:302-731-7782
Mailing Address - Fax:
Practice Address - Street 1:4701 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2055
Practice Address - Country:US
Practice Address - Phone:302-731-7782
Practice Address - Fax:302-738-5917
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064409207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103497QEGMedicare PIN
MD006MO120Medicare PIN
DE019557R71Medicare PIN