Organization
N THANNOLI PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATARAJAN THANNOLI MD (PRESIDENT OWNER)
(606) 677-0854
Entity
Organization
Contact information
Practice address
55 THANNOLI DR, SOMERSET, KY 42503
(606) 677-0854
(606) 677-9311
Mailing address
55 THANNOLI DR, SOMERSET, KY 42503
(606) 677-0854
(606) 677-9311
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000061076
BCBC GROUP #
KY
01
—
65946147
MEDICAID GROUP #
—
01
—
DF2752
RAILROAD MEDICARE GROUP
KY
Enumeration date
11/30/2006
Last updated
06/11/2012
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