Provider Demographics
NPI:1831464452
Name:THAKKAR, RASILA A (MD)
Entity Type:Individual
Prefix:DR
First Name:RASILA
Middle Name:A
Last Name:THAKKAR
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 1:2702 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2332
Mailing Address - Country:US
Mailing Address - Phone:607-785-5572
Mailing Address - Fax:
Practice Address - Street 1:2702 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-2332
Practice Address - Country:US
Practice Address - Phone:607-785-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169916208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice