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General NPI Number Information
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NPI Number | 1881646248
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Entity Type | Individual
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Provider Name | DHEERAJ TARANATH DO
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 12/15/2017
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Provider Practice Location Address
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Address Line | 16490 W 78TH ST
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City | EDEN PRAIRIE
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State | MN
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Zip | 55346-4300
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Country | US
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Telephone | 952-934-5332
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Fax |
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Provider Business Mailing Address
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Address Line | 3407 N 5TH STREET HWY
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City | READING
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State | PA
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Zip | 19605-2428
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Country | US
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Telephone | 610-939-8992
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Fax |
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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 | 25MB08627700
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License Number State | NJ
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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 | C2-0010487
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS012644
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License Number State | PA
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