Active NPI
Meena Thayu, M.D.
- Pediatric Gastroenterology Physician
- Philadelphia, PA
National Provider Identifier
1730118373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Gastroenterology Physician
- License
- MD419093
- Practice address
- 3401 Civic Center Blvd
Children'S Hospital of Philadelphia
Philadelphia, PA 19104-4319 - Phone
- (215) 590-1000
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD419093 | PA | |
| Pediatric Gastroenterology Physician | 2080P0206X | MD419093 | PA | Primary |
| Pediatrics Physician | 208000000X | 25MA07452500 | NJ | |
| Pediatric Gastroenterology Physician | 2080P0206X | 25MA07452500 | NJ |
Addresses
Primary practice location
3401 Civic Center Blvd
Children'S Hospital of Philadelphia
Philadelphia, PA 19104-4319
Mailing address
100 N 20TH St
Suite 301
Philadelphia, PA 19103-1443
Phone (215) 567-2422
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001915553 | Medicaid | PA | |
| 8905401 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA07452500 | NJ | MD | Pediatrics Physician |
| MD419093 | PA | MD | Pediatric Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332547200000",
"number": "1730118373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N 20TH ST",
"address_2": "SUITE 301",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191031443",
"telephone_number": "215-567-2422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"address_2": "CHILDREN'S HOSPITAL OF PHILADELPHIA",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319",
"telephone_number": "215-590-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THAYU",
"first_name": "MEENA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-03",
"last_updated": "2012-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD419093",
"primary": false
},
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "PA",
"license": "MD419093",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA07452500",
"primary": false
},
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "NJ",
"license": "25MA07452500",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001915553",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8905401",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.