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General NPI Number Information
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NPI Number | 1740527357
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Entity Type | Individual
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Provider Name | THARA BASAVAIAH M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 401 MATTHEW ST
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City | MARIETTA
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State | OH
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Zip | 45750-1635
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Country | US
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Telephone | 740-374-7700
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Fax | 740-374-7701
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Provider Business Mailing Address
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Address Line | 9 INDUSTRIAL RD STE 5
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City | MILFORD
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State | MA
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Zip | 01757-3736
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Country | US
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Telephone | 508-473-1480
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Fax | 508-473-1210
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.121464
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 35.121464
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 266249
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License Number State | MA
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