Provider Demographics
NPI:1811908064
Name:THAKKAR, VIPUL V (MD)
Entity type:Individual
Prefix:
First Name:VIPUL
Middle Name:V
Last Name:THAKKAR
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 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3253
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:228 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1158
Practice Address - Country:US
Practice Address - Phone:803-366-5186
Practice Address - Fax:803-366-5730
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350817892085R0001X
NC2007011822085R0001X
SC302292085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC199820OtherMEDCOST
NC811304OtherPARTNERS
NC3591870OtherCIGNA
SCN01182Medicaid
NC1460EOtherBLUE CROSS
NC5907146Medicaid
NC2068064AMedicare PIN
NC2068064CMedicare PIN
SCAA23726058Medicare PIN
OHTH7358601Medicare ID - Type Unspecified
NC2068064Medicare PIN
NC199820OtherMEDCOST
NC811304OtherPARTNERS
NC2068064BMedicare PIN