Provider Demographics
NPI:1255501136
Name:PARESH K THAKKAR MD LLC
Entity Type:Organization
Organization Name:PARESH K THAKKAR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-470-3592
Mailing Address - Street 1:13 WABANAKI WAY
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5524
Mailing Address - Country:US
Mailing Address - Phone:978-470-3592
Mailing Address - Fax:978-470-3592
Practice Address - Street 1:13 WABANAKI WAY
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5524
Practice Address - Country:US
Practice Address - Phone:978-470-3592
Practice Address - Fax:978-470-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53603208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty