Provider Demographics
NPI:1881646248
Name:TARANATH, DHEERAJ (DO)
Entity type:Individual
Prefix:
First Name:DHEERAJ
Middle Name:
Last Name:TARANATH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 N 5TH STREET HWY
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2428
Mailing Address - Country:US
Mailing Address - Phone:610-939-8992
Mailing Address - Fax:
Practice Address - Street 1:16490 W 78TH ST
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-4300
Practice Address - Country:US
Practice Address - Phone:952-934-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08627700207Q00000X
DEC2-0010487207Q00000X
PAOS012644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101465500001Medicaid
I24096Medicare UPIN
PA087446Medicare ID - Type Unspecified