Healthcare Provider Details

I. General information

NPI: 1891734430
Provider Name (Legal Business Name): THAYAPARAN MATHANAKARAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 W STATE ST SUITE 202
OLEAN NY
14760-1858
US

IV. Provider business mailing address

535 MAIN ST
OLEAN NY
14760-1500
US

V. Phone/Fax

Practice location:
  • Phone: 716-806-1137
  • Fax: 716-379-8472
Mailing address:
  • Phone: 716-806-1137
  • Fax: 585-625-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number251105
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number251105
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: