Individual
DR. ANANTH THYAGARAJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6035 BURKE CENTRE PKWY STE 330, BURKE, VA 22015-3750
(703) 323-3930
(703) 323-7457
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2644
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
0101247154
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356516546
—
VA
01
—
403996ZM8G
MEDICARE PTAN
DC
Enumeration date
04/28/2008
Last updated
12/04/2024
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