MEDICARE: TESSIE THARAKAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	163019-1	NY

General Provider Information

NPI Number	:	1811951882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSIE THARAKAN M.D.

Provider Business Mailing Address
First Line	:	3671 HUDSON MANOR TER
Second Line	:	#5J
City	:	BRONX
State	:	NY
Zip	:	10463-1137
Country	:	US
Telephone Number	:	718-601-8540
Fax Number	:

Provider Business Practice Location Address
First Line	:	3424 KOSSUTH AVE
Second Line	:	#7C-03
City	:	BRONX
State	:	NY
Zip	:	10467-2410
Country	:	US
Telephone Number	:	718-519-2141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	07/08/2007

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