Provider Demographics
NPI:1861412066
Name:MURUGASAN, JONATHAN (NP)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:MURUGASAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 R AND L SMITH DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-7924
Mailing Address - Country:US
Mailing Address - Phone:434-724-7490
Mailing Address - Fax:
Practice Address - Street 1:101 AUBREYS LOOP
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-5056
Practice Address - Country:US
Practice Address - Phone:434-517-3879
Practice Address - Fax:434-517-3989
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily