Provider Demographics
NPI:1982011615
Name:THARUMARAJAH, MALATHY (MD)
Entity Type:Individual
Prefix:
First Name:MALATHY
Middle Name:
Last Name:THARUMARAJAH
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 1:2212 PENFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1756
Mailing Address - Country:US
Mailing Address - Phone:585-598-8600
Mailing Address - Fax:
Practice Address - Street 1:2212 PENFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1756
Practice Address - Country:US
Practice Address - Phone:585-598-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324664207R00000X
MTMED-RES-LIC-42268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine