Provider Demographics
NPI:1316984693
Name:TIRUCHELVAM, JUNIA P (MD)
Entity type:Individual
Prefix:
First Name:JUNIA
Middle Name:P
Last Name:TIRUCHELVAM
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 1:116 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17401-1474
Mailing Address - Country:US
Mailing Address - Phone:717-845-8617
Mailing Address - Fax:717-854-0377
Practice Address - Street 1:116 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1474
Practice Address - Country:US
Practice Address - Phone:717-846-5846
Practice Address - Fax:717-854-0377
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040084L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATI565655OtherHIGHMARK BLUE SHIELD
PAE23200OtherHEALTH AMERICA/HEALTH ASS
PA565655EBXMedicare ID - Type Unspecified
PAE23200Medicare UPIN