Basic Information
| Provider Information | |||||||||
| NPI: | 1942309844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAMBURAJ | ||||||||
| FirstName: | VIMALA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66737 OLD TWENTY ONE RD | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437258987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404391371 | ||||||||
| FaxNumber: | 7404321954 | ||||||||
| Practice Location | |||||||||
| Address1: | 66737 OLD TWENTY ONE RD | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437258987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404391371 | ||||||||
| FaxNumber: | 7404321954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-040713 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.