Provider Demographics
NPI:1710338363
Name:THANDAMPALLAYAM AJJEYA GOWDER, MANGAYARKARASI (MD)
Entity Type:Individual
Prefix:
First Name:MANGAYARKARASI
Middle Name:
Last Name:THANDAMPALLAYAM AJJEYA GOWDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S LIMESTONE ROOM L-445
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY, DEPARTMENT OF NEUROLOGY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-218-5038
Mailing Address - Fax:859-257-0754
Practice Address - Street 1:740 S LIMESTONE STE B101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-5661
Practice Address - Fax:859-323-6411
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY574292084N0400X, 207WX0109X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program