Individual
BERRY CHERIYAN THAVALATHIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(405) 456-1000
Mailing address
921 NE 13TH ST, OKLAHOMA CITY, OK 73104-5007
(787) 653-6060
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
21860
PR
261QR1300X
Rural Health Clinic/Center
21860
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851939326
N/A
—
Enumeration date
12/16/2019
Last updated
05/15/2021
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