Provider Demographics
NPI:1265455604
Name:DAMODARAN, THARA RANI (MD)
Entity type:Individual
Prefix:DR
First Name:THARA RANI
Middle Name:
Last Name:DAMODARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THARA RANI
Other - Middle Name:
Other - Last Name:VINU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 20490
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0490
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:480-296-7665
Practice Address - Street 1:1925 NW 142ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6193
Practice Address - Country:US
Practice Address - Phone:405-706-3117
Practice Address - Fax:877-349-5185
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35774207RI0200X
OK31085207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease