Provider Demographics
NPI:1225120298
Name:THAKKER, DILIP M (MD)
Entity Type:Individual
Prefix:DR
First Name:DILIP
Middle Name:M
Last Name:THAKKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1629
Mailing Address - Country:US
Mailing Address - Phone:518-725-6868
Mailing Address - Fax:
Practice Address - Street 1:10 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1629
Practice Address - Country:US
Practice Address - Phone:518-725-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01265810Medicaid
NY52770BMedicare ID - Type Unspecified
NYE93227Medicare UPIN