Provider Demographics
NPI:1548255177
Name:THANGAVELU, ARASI (MD)
Entity type:Individual
Prefix:DR
First Name:ARASI
Middle Name:
Last Name:THANGAVELU
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 1:1400 VILLAGE SQUARE BLVD STE 3-258
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1250
Mailing Address - Country:US
Mailing Address - Phone:850-518-4325
Mailing Address - Fax:
Practice Address - Street 1:1400 VILLAGE SQUARE BLVD STE 3-258
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1250
Practice Address - Country:US
Practice Address - Phone:850-545-9376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051771207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000954159DMedicaid
GA52008844-003OtherBCBS
GA000954159GMedicaid
GA336307OtherWELLCARE
GA52008844002OtherBCBS
GA930123503OtherRAILROAD MEDICARE
GA000954159GMedicaid
GA93BDRRFMedicare PIN