Provider Demographics
NPI:1790832822
Name:THACKER, NEELAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELAM
Middle Name:
Last Name:THACKER
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 1:101 MAIN STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4530
Mailing Address - Country:US
Mailing Address - Phone:781-396-8100
Mailing Address - Fax:781-391-9929
Practice Address - Street 1:101 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4530
Practice Address - Country:US
Practice Address - Phone:781-396-8100
Practice Address - Fax:781-391-9929
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238151207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology