Provider Demographics
NPI:1346234176
Name:THAKKAR, MADHVI M (MD)
Entity Type:Individual
Prefix:
First Name:MADHVI
Middle Name:M
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NASH MEDICAL ARTS MALL
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1410
Mailing Address - Country:US
Mailing Address - Phone:252-451-3200
Mailing Address - Fax:252-937-6278
Practice Address - Street 1:600 NASH MEDICAL ARTS MALL
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1410
Practice Address - Country:US
Practice Address - Phone:252-451-3200
Practice Address - Fax:252-937-6278
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1188KOtherBCBSNC
NC891188KMedicaid
NC84155OtherMEDCOST
NC110181322OtherRAILROAD MEDICARE
NC6719614OtherCIGNA HEALTHCARE
NC891188KMedicaid
NC2265973Medicare PIN