Provider Demographics
NPI:1285905117
Name:A.N. DAMODARAN, M.D. INC.
Entity type:Organization
Organization Name:A.N. DAMODARAN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:A.
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAMODARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-207-5050
Mailing Address - Street 1:2 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-1416
Mailing Address - Country:US
Mailing Address - Phone:574-207-5050
Mailing Address - Fax:574-207-5002
Practice Address - Street 1:2 S PEARL ST
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-1416
Practice Address - Country:US
Practice Address - Phone:574-207-5050
Practice Address - Fax:574-207-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028450A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE15281Medicare UPIN