Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 35046061A | OH |
NPI | 1013011170 |
---|---|
Provider Name | Thangaraj Amaran |
First Address | Celina, OH 45822 |
Second Address | Celina, OH 45822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000130996 | BCBS (01) | |
0457330 | (05) | OH |
A15035 | (02) |