Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD61019288 | WA |
N | 111NI0900X | Internist | MD61019288 | WA |
N | 207RN0300X | Nephrologist | MD61019288 | WA |
NPI | 1023423704 |
---|---|
Provider Name | Dr. Braghadheeswar Thyagarajan |
First Address | Richland, WA 99352-9532 |
Second Address | Richland, WA 99352-3514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2014 |
Last Update Date | 13/05/2020 |