Provider Demographics
NPI:1992851802
Name:N SHAH THAKER, MD INC.
Entity Type:Organization
Organization Name:N SHAH THAKER, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIRANJANA
Authorized Official - Middle Name:SHAH
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-439-9797
Mailing Address - Street 1:88 CENTER RD
Mailing Address - Street 2:250
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2700
Mailing Address - Country:US
Mailing Address - Phone:440-439-9797
Mailing Address - Fax:440-439-9775
Practice Address - Street 1:88 CENTER RD
Practice Address - Street 2:250
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2700
Practice Address - Country:US
Practice Address - Phone:440-439-9797
Practice Address - Fax:440-439-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041778207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2744187Medicaid
OH9368311Medicare PIN