Provider Demographics
NPI:1598723132
Name:THAKKAR, JASHVANTLAL K (MD)
Entity Type:Individual
Prefix:
First Name:JASHVANTLAL
Middle Name:K
Last Name:THAKKAR
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:PO BOX 3739
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25337
Mailing Address - Country:US
Mailing Address - Phone:304-342-8579
Mailing Address - Fax:304-342-8273
Practice Address - Street 1:331 LAIDLEY STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-342-8579
Practice Address - Fax:304-342-8273
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17226207RC0000X
TXJ1407207RC0000X
IL036373769207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0075517000Medicaid
0735712Medicare ID - Type UnspecifiedINDIVIDUAL
WV0075517000Medicaid
E19295Medicare UPIN