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General NPI Number Information
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NPI Number | 1275784555
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Entity Type | Individual
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Provider Name | JOLSON KORAH THARAKAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 4001 LONG PRAIRIE RD STE 160
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City | FLOWER MOUND
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State | TX
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Zip | 75028-1528
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Country | US
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Telephone | 972-355-1505
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Fax | 972-355-1095
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Provider Business Mailing Address
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Address Line | 648 GRASSFIELD PKWY SUITE 1
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City | CHESAPEAKE
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State | VA
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Zip | 23322-7465
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Country | US
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Telephone | 757-738-1325
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Fax | 757-312-9353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101257823
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T0015
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License Number State | TX
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