Provider Demographics
NPI:1538333174
Name:THORAT, SACHIN BABANAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SACHIN
Middle Name:BABANAO
Last Name:THORAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-741-2900
Mailing Address - Fax:318-741-2999
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-741-2900
Practice Address - Fax:318-741-2999
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO25000110492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicare PIN