Basic Information
| Provider Information | |||||||||
| NPI: | 1265455604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAMODARAN | ||||||||
| FirstName: | THARA RANI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VINU | ||||||||
| OtherFirstName: | THARA RANI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13313 N MERIDIAN AVE | ||||||||
| Address2: | BUILDING D | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055295759 | ||||||||
| FaxNumber: | 4055295760 | ||||||||
| Practice Location | |||||||||
| Address1: | 13313 N MERIDIAN AVE | ||||||||
| Address2: | BUILDING D | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055295759 | ||||||||
| FaxNumber: | 4055295760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 35774 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 31085 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.