Provider Demographics
NPI:1639303258
Name:THAKOR, RUPAL H (MD)
Entity type:Individual
Prefix:
First Name:RUPAL
Middle Name:H
Last Name:THAKOR
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 1:235 PLAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3241
Mailing Address - Country:US
Mailing Address - Phone:401-272-0127
Mailing Address - Fax:401-421-0159
Practice Address - Street 1:235 PLAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3241
Practice Address - Country:US
Practice Address - Phone:401-272-0127
Practice Address - Fax:401-421-0159
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446548207Q00000X
RIMD15534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014582OtherHIGHMARK
PA256757D4ZMedicare PIN