Provider Demographics
NPI:1790701712
Name:THAKUR, RAJBALA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJBALA
Middle Name:
Last Name:THAKUR
Suffix:
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5982
Mailing Address - Fax:585-756-0169
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5982
Practice Address - Fax:585-756-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199637207L00000X, 207LH0002X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7152065OtherAETNA
NY00040826601OtherUNIVERA
NY00040826602OtherUNIVERA PTC
NY01576021Medicaid
NYG0189393590OtherBLUE CHOICE PTC GROUP
NY000912439001OtherBS WNY/HEALTHNOW
NY5398992OtherGHI
NYG0189393590OtherBLUE CHOICE GROUP
NYMDG079OtherPREFERRED CARE PTC
NY199637-0OtherWORKER'S COMP
NY2222OtherBLUE SHIELD GROUP
NY050059021OtherRAILROAD MEDICARE
NY058157OtherMVP PROVIDER
NYMDA531OtherPREFERRED CARE
NYP010199637OtherBLUE CHOICE PTC
NY00040826602OtherUNIVERA PTC
NY16536HMedicare ID - Type UnspecifiedMEDICARE