Provider Demographics
NPI:1356394050
Name:SABANAYAGAM, MUTHIAH KRISHNASAMY (MD)
Entity type:Individual
Prefix:DR
First Name:MUTHIAH
Middle Name:KRISHNASAMY
Last Name:SABANAYAGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 CLARA CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8121
Mailing Address - Country:US
Mailing Address - Phone:919-735-9119
Mailing Address - Fax:
Practice Address - Street 1:916 ELEVENTH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1616
Practice Address - Country:US
Practice Address - Phone:919-735-9119
Practice Address - Fax:919-735-9120
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC316392084F0202X, 2084P0800X, 2084P0802X, 2084P0804X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974152Medicaid
NC372582OtherMANAGED HEALTH NETWORK
NC372582OtherMANAGED HEALTH NETWORK
NC2349242Medicare ID - Type UnspecifiedGROUP PRICING NUMBER