Provider Demographics
NPI:1457367112
Name:THARIAN, ANITA (DO)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:THARIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18601 LBJ FWY STE 315
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5612
Mailing Address - Country:US
Mailing Address - Phone:469-547-6541
Mailing Address - Fax:469-547-6545
Practice Address - Street 1:18601 LBJ FWY STE 315
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5612
Practice Address - Country:US
Practice Address - Phone:469-547-6541
Practice Address - Fax:469-547-6545
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0588207R00000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173978101Medicaid
TX173978103Medicaid
TX173978104Medicaid
TX173978103Medicaid
TXTXB124133Medicare PIN
TXTXB124092Medicare PIN
TXTXB124134Medicare PIN