Provider Demographics
NPI:1780732552
Name:THAKUR, RANJANA (MD)
Entity type:Individual
Prefix:
First Name:RANJANA
Middle Name:
Last Name:THAKUR
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 1:390 AMWELL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844
Mailing Address - Country:US
Mailing Address - Phone:908-431-9911
Mailing Address - Fax:908-431-9937
Practice Address - Street 1:390 AMWELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844
Practice Address - Country:US
Practice Address - Phone:908-431-9911
Practice Address - Fax:908-431-9937
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07281400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8696004Medicaid
NJ8696004Medicaid
052102(R5V)Medicare ID - Type Unspecified