Provider Demographics
NPI:1255892642
Name:THAKUR, SWETA JHA (MD)
Entity type:Individual
Prefix:
First Name:SWETA
Middle Name:JHA
Last Name:THAKUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWETA
Other - Middle Name:
Other - Last Name:JHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 70157
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0021
Mailing Address - Country:US
Mailing Address - Phone:843-516-2024
Mailing Address - Fax:843-796-1319
Practice Address - Street 1:9021 BELLA VERDE CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-5110
Practice Address - Country:US
Practice Address - Phone:843-516-2024
Practice Address - Fax:843-796-1319
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC89902208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program