Provider Demographics
NPI:1124635032
Name:NAIDU, THATCHA (PA)
Entity type:Individual
Prefix:
First Name:THATCHA
Middle Name:
Last Name:NAIDU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 W I 240 SERVICE RD STE F100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2134
Mailing Address - Country:US
Mailing Address - Phone:405-682-8383
Mailing Address - Fax:405-265-5230
Practice Address - Street 1:1145 W I 240 SERVICE RD STE F100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2134
Practice Address - Country:US
Practice Address - Phone:405-682-8383
Practice Address - Fax:405-265-5230
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4457363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical