Provider Demographics
NPI:1083719231
Name:THAKRAR, MAHENDRA O (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:O
Last Name:THAKRAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAHENDRAKUMAR
Other - Middle Name:O
Other - Last Name:THAKRAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2608 MATLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2525
Mailing Address - Country:US
Mailing Address - Phone:817-861-4499
Mailing Address - Fax:817-861-8411
Practice Address - Street 1:2608 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2525
Practice Address - Country:US
Practice Address - Phone:817-861-4499
Practice Address - Fax:817-861-8411
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7299207V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1140253-01Medicaid
TXD69179Medicare UPIN
TX1140253-01Medicaid
TX00AP92Medicare Oscar/Certification