Provider Demographics
NPI:1265762868
Name:A. M .A. R THANADAR, MD, PC
Entity type:Organization
Organization Name:A. M .A. R THANADAR, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABU
Authorized Official - Middle Name:R
Authorized Official - Last Name:THANADAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-397-0709
Mailing Address - Street 1:301 GOODE WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2266
Mailing Address - Country:US
Mailing Address - Phone:757-397-0709
Mailing Address - Fax:757-397-8751
Practice Address - Street 1:301 GOODE WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2266
Practice Address - Country:US
Practice Address - Phone:757-397-0709
Practice Address - Fax:757-397-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024774208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty