Basic Information
Provider Information | |||||||||
NPI: | 1952435919 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | THIAGARAJAH | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: | K | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1800 EMERSON ST, STE 200 | ||||||||
Address2: |   | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 80218 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3034688844 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 592 SPRINGFIELD AVE | ||||||||
Address2: |   | ||||||||
City: | WESTFIELD | ||||||||
State: | NJ | ||||||||
PostalCode: | 070901002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9087898999 | ||||||||
FaxNumber: | 9087891379 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2007 | ||||||||
LastUpdateDate: | 05/25/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | DR27698 | CO | N |   | Allopathic & Osteopathic Physicians | Plastic Surgery |   | 207W00000X | 35.088281 | OH | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 000000511204 | 01 |   | FACET | OTHER | 2756012 | 05 | OH |   | MEDICAID | 200854040 | 05 | IN |   | MEDICAID | 98806033 | 05 | CO |   | MEDICAID |