Provider Demographics
NPI:1508874470
Name:THAKAR, HIMAL (MD)
Entity Type:Individual
Prefix:
First Name:HIMAL
Middle Name:
Last Name:THAKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HIMAL
Other - Middle Name:
Other - Last Name:LAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1625 STRAITS TPKE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1836
Mailing Address - Country:US
Mailing Address - Phone:203-573-9512
Mailing Address - Fax:203-568-2904
Practice Address - Street 1:64 ROBBINS ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2613
Practice Address - Country:US
Practice Address - Phone:203-573-6263
Practice Address - Fax:203-573-6030
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004033200207RI0200X
CT046713208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
198531OtherBLUE CROSS BLUE SHIELD
7614689OtherAETNA
MO207313305Medicaid
704270OtherHEALTHLINK
198531OtherBLUE CROSS BLUE SHIELD
IN070860JJJMedicare PIN
I36753Medicare UPIN
MO933350247Medicare PIN