Healthcare Provider Details

I. General information

NPI: 1538747894
Provider Name (Legal Business Name): JENNIFER B THARAKAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 WHITNEY AVE STE 240
HAMDEN CT
06518-3603
US

IV. Provider business mailing address

2080 WHITNEY AVE STE 240
HAMDEN CT
06518-3603
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-6228
  • Fax: 203-248-2881
Mailing address:
  • Phone: 203-281-6228
  • Fax: 203-248-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77010
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: