Provider Demographics
NPI:1467769901
Name:THARAROOP, JEREMY (RD, LD)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:THARAROOP
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25587 CONIFER RD # 105-512
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9067
Mailing Address - Country:US
Mailing Address - Phone:303-276-0282
Mailing Address - Fax:833-765-8253
Practice Address - Street 1:25587 CONIFER RD # 105-512
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9067
Practice Address - Country:US
Practice Address - Phone:303-276-0282
Practice Address - Fax:833-765-8253
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81739133V00000X
MTMED-NUTR-LIC-63973133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered