Provider Demographics
NPI:1912262866
Name:THIRUCHELVAM, NIROSSHAN (MD)
Entity Type:Individual
Prefix:
First Name:NIROSSHAN
Middle Name:
Last Name:THIRUCHELVAM
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 1:30073 SHADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-7803
Mailing Address - Country:US
Mailing Address - Phone:718-640-0168
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:G 91
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-5612
Practice Address - Country:US
Practice Address - Phone:216-444-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.123863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine