Provider Demographics
NPI:1699806596
Name:JASHVANTLAL K. THAKKAR, M. D.
Entity Type:Organization
Organization Name:JASHVANTLAL K. THAKKAR, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:HITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-342-8579
Mailing Address - Street 1:PO BOX 3739
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25337-3739
Mailing Address - Country:US
Mailing Address - Phone:304-342-8579
Mailing Address - Fax:304-342-8273
Practice Address - Street 1:331 LAIDLEY ST
Practice Address - Street 2:SUITE 208
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1619
Practice Address - Country:US
Practice Address - Phone:304-342-8579
Practice Address - Fax:304-342-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17226174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4000126000Medicaid
WV9303921Medicare ID - Type Unspecified
WVE19295Medicare UPIN