Provider Demographics
NPI:1972819894
Name:THIRUVALLUR VALLABHAN, MD, PA
Entity type:Organization
Organization Name:THIRUVALLUR VALLABHAN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THIRUVALLUR
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALLABHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-638-1705
Mailing Address - Street 1:8630 E COUNTY ROAD 466
Mailing Address - Street 2:SUITE A
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5613
Mailing Address - Country:US
Mailing Address - Phone:352-638-1705
Mailing Address - Fax:
Practice Address - Street 1:8630 E COUNTY ROAD 466
Practice Address - Street 2:SUITE A
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5613
Practice Address - Country:US
Practice Address - Phone:352-638-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty