Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB08455100 | NJ |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 143541 | MD |
NPI | 1124275334 |
---|---|
Provider Name | Dr. Nilay Bhasker Thaker |
First Address | Baltimore, MD 21297-3086 |
Second Address | Frederick, MD 21702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 30/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187277YTKH | (02) | MD |