Provider Demographics
NPI:1386833549
Name:THAKER, PRAMOD B (MD)
Entity Type:Individual
Prefix:
First Name:PRAMOD
Middle Name:B
Last Name:THAKER
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 1:1620 WORCESTER RD
Mailing Address - Street 2:NO. 348B
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5451
Mailing Address - Country:US
Mailing Address - Phone:508-875-2310
Mailing Address - Fax:
Practice Address - Street 1:1620 WORCESTER RD
Practice Address - Street 2:NO 348B
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5451
Practice Address - Country:US
Practice Address - Phone:508-875-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43476208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice