Provider Demographics
NPI:1659503761
Name:THORAT, SAVITA SACHIN (M D)
Entity Type:Individual
Prefix:
First Name:SAVITA
Middle Name:SACHIN
Last Name:THORAT
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:SAVITA
Other - Middle Name:GULABRAO
Other - Last Name:CHAVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:2300 HOSPITAL DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2394
Mailing Address - Country:US
Mailing Address - Phone:318-212-7520
Mailing Address - Fax:318-212-7519
Practice Address - Street 1:2300 HOSPITAL DR
Practice Address - Street 2:SUITE 180
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2394
Practice Address - Country:US
Practice Address - Phone:318-212-7520
Practice Address - Fax:318-212-7519
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1659503761Medicaid
MO132300240Medicare PIN