Provider Demographics
NPI:1013011170
Name:AMARAN, THANGARAJ (MD)
Entity Type:Individual
Prefix:
First Name:THANGARAJ
Middle Name:
Last Name:AMARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 SOUTH MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822
Mailing Address - Country:US
Mailing Address - Phone:419-586-6899
Mailing Address - Fax:419-586-6799
Practice Address - Street 1:950 SOUTH MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822
Practice Address - Country:US
Practice Address - Phone:419-586-6899
Practice Address - Fax:419-586-6799
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046061A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457330Medicaid
000000130996OtherBCBS
OH0457330Medicaid
0496711Medicare ID - Type Unspecified