Provider Demographics
NPI:1982717302
Name:THAKKER, SURESH CHANDRA PRABHUDAS (MD)
Entity Type:Individual
Prefix:MR
First Name:SURESH CHANDRA
Middle Name:PRABHUDAS
Last Name:THAKKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9612
Mailing Address - Country:US
Mailing Address - Phone:740-439-0733
Mailing Address - Fax:740-439-8996
Practice Address - Street 1:1420 CLARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9617
Practice Address - Country:US
Practice Address - Phone:740-435-4020
Practice Address - Fax:404-354-0297
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064765-T208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0926207Medicaid