=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679137764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC LAURON THARMATHURAI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2019
-----------------------------------------------------
Last Update Date | 06/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7309 SENECA RD N STE 109
-----------------------------------------------------
City | HORNELL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14843-9691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-385-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7309 SENECA RD N STE 109
-----------------------------------------------------
City | HORNELL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14843-9691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-385-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 80092-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 322331
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------