Provider Demographics
NPI:1801811542
Name:THACKER, CHADWARD (MD)
Entity type:Individual
Prefix:DR
First Name:CHADWARD
Middle Name:
Last Name:THACKER
Suffix:
Gender:M
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:PO BOX 1228
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-1228
Mailing Address - Country:US
Mailing Address - Phone:606-509-2000
Mailing Address - Fax:606-509-2002
Practice Address - Street 1:140 ADAMS LN STE 600-700
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3087
Practice Address - Country:US
Practice Address - Phone:606-509-2000
Practice Address - Fax:606-509-2002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64092638Medicaid
KY64092638Medicaid
KYK038880Medicare PIN