Provider Demographics
NPI:1699865063
Name:DORAN, THAO (DO)
Entity type:Individual
Prefix:DR
First Name:THAO
Middle Name:
Last Name:DORAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 STORRS RD # 134
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2251
Mailing Address - Country:US
Mailing Address - Phone:860-245-1269
Mailing Address - Fax:
Practice Address - Street 1:14 JONES HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1448
Practice Address - Country:US
Practice Address - Phone:860-295-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699865063OtherNPI