Provider Demographics
NPI:1962579136
Name:N THANNOLI PSC
Entity type:Organization
Organization Name:N THANNOLI PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATARAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THANNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-677-0854
Mailing Address - Street 1:55 THANNOLI DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503
Mailing Address - Country:US
Mailing Address - Phone:606-677-0854
Mailing Address - Fax:606-677-9311
Practice Address - Street 1:55 THANNOLI DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-677-0854
Practice Address - Fax:606-677-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDF2752OtherRAILROAD MEDICARE GROUP
65946147OtherMEDICAID GROUP #
KY000000061076OtherBCBC GROUP #
KY6807Medicare ID - Type UnspecifiedMEDICARE GROUP