Provider Demographics
NPI:1831115484
Name:DAMODARAN, ANANDHAKRISHNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANDHAKRISHNAN
Middle Name:
Last Name:DAMODARAN
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 1:800 W RANDOL MILL RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2504
Mailing Address - Country:US
Mailing Address - Phone:817-960-6648
Mailing Address - Fax:817-960-6649
Practice Address - Street 1:800 W RANDOL MILL RD STE 2300
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-960-6648
Practice Address - Fax:817-960-6649
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086929207R00000X
TXN2458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine