Provider Demographics
NPI:1598845141
Name:THAKKER, CHANDRANI GANPAT VI (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRANI
Middle Name:GANPAT
Last Name:THAKKER
Suffix:VI
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 1:800 PENNSYLVANIA AVE
Mailing Address - Street 2:CHILDRENS MEDICINE CENTER
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3351
Mailing Address - Country:US
Mailing Address - Phone:304-388-2525
Mailing Address - Fax:304-388-2537
Practice Address - Street 1:800 PENNSYLVANIA AVE
Practice Address - Street 2:CHILDRENS MEDICINE CENTER
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3351
Practice Address - Country:US
Practice Address - Phone:304-388-2525
Practice Address - Fax:304-388-2537
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12966208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0112794000Medicaid
WV12966OtherMEDICAL LICENSE
WV0112794000Medicaid
WVH27816Medicare UPIN