Provider Demographics
NPI:1326340621
Name:THANAGARAJ AMARAN, M.D., INC.
Entity Type:Organization
Organization Name:THANAGARAJ AMARAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANGARAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-586-6899
Mailing Address - Street 1:950 S MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2479
Mailing Address - Country:US
Mailing Address - Phone:419-586-6899
Mailing Address - Fax:419-586-6799
Practice Address - Street 1:950 S MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2479
Practice Address - Country:US
Practice Address - Phone:419-586-6899
Practice Address - Fax:419-586-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-6061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0457330Medicaid
OH0457330Medicaid