Provider Demographics
NPI:1275784555
Name:THARAKAN, JOLSON KORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOLSON
Middle Name:KORAH
Last Name:THARAKAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:648 GRASSFIELD PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7465
Mailing Address - Country:US
Mailing Address - Phone:757-738-1325
Mailing Address - Fax:757-312-9353
Practice Address - Street 1:648 GRASSFIELD PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7465
Practice Address - Country:US
Practice Address - Phone:757-738-1325
Practice Address - Fax:757-312-9353
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2015-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101257823207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVG788AMedicare PIN