| Thara Damodaran Md Llc | |
|
515 N Mesa Dr Mesa AZ 85201-5914 | |
| (480) 720-8744 | |
| (480) 656-9802 |
| Full Name | Thara Damodaran Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 515 N Mesa Dr, Mesa, Arizona |
| Authorized Official Name and Position | Thara R Damodaran (OWNER) |
| Authorized Official Contact | 4807208744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thara Damodaran Md Llc Po Box 1518 Gilbert AZ 85299-1518 Ph: (602) 377-7103 | Thara Damodaran Md Llc 515 N Mesa Dr Mesa AZ 85201-5914 Ph: (480) 720-8744 |
| NPI Number | 1023237864 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6709983885 |
|---|---|
| Medicare Enrollment ID | O20150923003122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023237864 | NPI | - | NPPES |
| L13560915 | Other | AZ | ORGANIZATION REGISTRATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 35774 (Arizona) | Primary |
| Provider Name | Thara R Damodaran |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1265455604 PECOS PAC ID: 9133125917 Enrollment ID: I20150924001243 |
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