Provider Demographics
NPI:1942309844
Name:THAMBURAJ, VIMALA (M D)
Entity Type:Individual
Prefix:
First Name:VIMALA
Middle Name:
Last Name:THAMBURAJ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66737 OLD TWENTY ONE RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-8987
Mailing Address - Country:US
Mailing Address - Phone:740-439-1371
Mailing Address - Fax:740-432-1954
Practice Address - Street 1:66737 OLD TWENTY ONE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8987
Practice Address - Country:US
Practice Address - Phone:740-439-1371
Practice Address - Fax:740-432-1954
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-040713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A78960Medicare UPIN
OHTH4069121Medicare ID - Type Unspecified