Provider Demographics
NPI:1114410982
Name:THAKORE, RACHEL VATSAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:VATSAL
Last Name:THAKORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVENUE TOWERS 4300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-1680
Mailing Address - Fax:931-202-8862
Practice Address - Street 1:7123 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2203
Practice Address - Country:US
Practice Address - Phone:773-586-4506
Practice Address - Fax:630-495-1770
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.159687207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1114410982Medicaid