Provider Demographics
NPI:1811167042
Name:THARMARAJAH, MARCELLE (MD)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:
Last Name:THARMARAJAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10464 SW 128TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5521
Mailing Address - Country:US
Mailing Address - Phone:305-878-2626
Mailing Address - Fax:
Practice Address - Street 1:10464 SW 128TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5521
Practice Address - Country:US
Practice Address - Phone:305-878-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58559207Q00000X
KY51996207Q00000X
FLME102257207Q00000X, 208M00000X
OH35.135492207Q00000X
FLME1022257207QA0505X
GA61361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist