1316916505 NPI number — DR. MULJIBHAI J THAKKAR MD

Table of content: DR. MULJIBHAI J THAKKAR MD (NPI 1316916505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316916505 NPI number — DR. MULJIBHAI J THAKKAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THAKKAR
Provider First Name:
MULJIBHAI
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316916505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6719 GOVERNOR G.C. PEERY HWY
Provider Second Line Business Mailing Address:
SUITE 2600
Provider Business Mailing Address City Name:
RICHLANDS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24641-0279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-964-6649
Provider Business Mailing Address Fax Number:
276-964-5007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6719 GOVERNOR G.C. PEERY HWY
Provider Second Line Business Practice Location Address:
SUITE 2600
Provider Business Practice Location Address City Name:
RICHLANDS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24641-0279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-964-6649
Provider Business Practice Location Address Fax Number:
276-964-5007
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101031664 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0087219000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011104800 . This is a "FEDERAL BLACK LUNG PROGRAM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 64661788 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003658 . This is a "UNITED MINE WORKERS ASSOCIATION" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 006088414 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060108 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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