# THARA DAMODARAN MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023237864
- **Authorized official:** DR. THARA R DAMODARAN M.D. (OWNER)
- **Authorized official phone:** (480) 720-8744

## Contact information

- **Practice address:** 1925 NW 142ND ST, OKLAHOMA CITY, OK 73134-6193
- **Practice address phone:** (405) 706-3117
- **Practice address fax:** (877) 349-5185
- **Mailing address:** PO BOX 20490, MESA, AZ 85277-0490
- **Mailing address phone:** (480) 985-1093
- **Mailing address fax:** (480) 296-7665

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | 35774 | AZ | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 02/07/2025