Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E-13046 | AR |
NPI | 1003340621 |
---|---|
Provider Name | Thirosha Thirunavukarasu |
First Address | Midlothian, VA 23113-7327 |
Second Address | Midlothian, VA 23113-7327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 21/06/2021 |