| Thara Damodaran Md Llc | |
|
1925 Nw 142nd St Oklahoma City OK 73134-6193 | |
| (405) 706-3117 | |
| (877) 349-5185 |
| Full Name | Thara Damodaran Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1925 Nw 142nd St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Thara R Damodaran (OWNER) |
| Authorized Official Contact | 4807208744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thara Damodaran Md Llc Po Box 20490 Mesa AZ 85277-0490 Ph: (480) 985-1093 | Thara Damodaran Md Llc 1925 Nw 142nd St Oklahoma City OK 73134-6193 Ph: (405) 706-3117 |
| NPI Number | 1023237864 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 02/07/2025 |
| Medicare PECOS PAC ID | 6709983885 |
|---|---|
| Medicare Enrollment ID | O20150923003122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023237864 | NPI | - | NPPES |
| L13560915 | Other | AZ | ORGANIZATION REGISTRATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 35774 (Arizona) | Primary |
| Provider Name | Thara R Damodaran |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1265455604 PECOS PAC ID: 9133125917 Enrollment ID: I20150924001243 |
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