Provider Demographics
NPI:1336444595
Name:THARIAN, ANTONIA (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:THARIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:THOMAS
Other - Last Name:KURISINKAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-8478
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-4870
Practice Address - Country:US
Practice Address - Phone:631-444-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine