Provider Demographics
NPI:1225022056
Name:THAKKAR, MAITREYA B (MD)
Entity Type:Individual
Prefix:
First Name:MAITREYA
Middle Name:B
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:901 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8467
Practice Address - Country:US
Practice Address - Phone:252-937-0229
Practice Address - Fax:252-937-3109
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9800714207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11362OtherBCBSNC
NC79995OtherMEDCOST
NC2993265OtherCIGNA HEALTHCARE
NC60050775OtherRAILROAD MEDICARE
NC8911362Medicaid
NCG70969Medicare UPIN
NC8911362Medicaid