Organization
THARA DAMODARAN MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THARA R DAMODARAN M.D. (OWNER)
(480) 720-8744
Entity
Organization
Contact information
Practice address
1925 NW 142ND ST, OKLAHOMA CITY, OK 73134-6193
(405) 706-3117
(877) 349-5185
Mailing address
PO BOX 20490, MESA, AZ 85277-0490
(480) 985-1093
(480) 296-7665
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
35774
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L13560915
ORGANIZATION REGISTRATION
AZ
Enumeration date
04/24/2007
Last updated
02/07/2025
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