Basic Information
| Provider Information | |||||||||
| NPI: | 1386689677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIAGARAJAH | ||||||||
| FirstName: | MAHESH | ||||||||
| MiddleName: | CANDIAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 E MOCKINGBIRD LN | ||||||||
| Address2: | 1108 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752065364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142171911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750573629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724201000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 07/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L9928 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 174068002 | 05 | TX | MEDICAID | 174068004 | 05 | TX | MEDICAID | P00364150 | 01 | TX | RAILROAD | OTHER | 174068003 | 05 | TX | MEDICAID | 8W0730 | 01 | TX | BCBS | OTHER | 8W1782 | 01 | TX | BCBS | OTHER |