Provider Demographics
NPI:1316977846
Name:OHANRAHAN, TIGHE RODERICK (MD)
Entity type:Individual
Prefix:
First Name:TIGHE
Middle Name:RODERICK
Last Name:OHANRAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LA CASA VIA
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3094
Mailing Address - Country:US
Mailing Address - Phone:925-934-5380
Mailing Address - Fax:925-934-5192
Practice Address - Street 1:120 LA CASA VIA
Practice Address - Street 2:SUITE 106
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3094
Practice Address - Country:US
Practice Address - Phone:925-934-5380
Practice Address - Fax:925-934-5192
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42122Medicare UPIN
00G239970Medicare ID - Type Unspecified