Provider Demographics
NPI:1689097313
Name:THANENDRARAJAN, SHARMILAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SHARMILAN
Middle Name:
Last Name:THANENDRARAJAN
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 1:4301 WEST MARKHAM STREET
Mailing Address - Street 2:SLOT 816
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-526-6990
Mailing Address - Fax:501-526-2273
Practice Address - Street 1:4301 WEST MARKHAM STREET
Practice Address - Street 2:SLOT 816
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-526-6990
Practice Address - Fax:501-526-2273
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8588207RH0003X, 207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine