Provider Demographics
NPI:1023499571
Name:THANGARAJ, SWAMINATHAN (DO)
Entity type:Individual
Prefix:DR
First Name:SWAMINATHAN
Middle Name:
Last Name:THANGARAJ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1340
Mailing Address - Country:US
Mailing Address - Phone:617-383-4082
Mailing Address - Fax:617-540-5120
Practice Address - Street 1:1119 E WEST HWY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4852
Practice Address - Country:US
Practice Address - Phone:202-360-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00893192084P0804X
PAOT0166402084P0800X
MA2883672084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry