Provider Demographics
NPI:1235869371
Name:THAKUR, SATYAM KUMAR
Entity Type:Individual
Prefix:
First Name:SATYAM
Middle Name:KUMAR
Last Name:THAKUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ROBERT RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-6527
Mailing Address - Country:US
Mailing Address - Phone:508-305-2319
Mailing Address - Fax:
Practice Address - Street 1:63 FOUNTAIN ST # 401
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6279
Practice Address - Country:US
Practice Address - Phone:413-277-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26113208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100210464788OtherMASS HEALTH