Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5821 | NE |
Y | 207Q00000X | Family Doctor | MD443133 | PA |
N | 207SG0201X | Clinical Genetics (M.D.) | MD443133 | PA |
NPI | 1043467194 |
---|---|
Provider Name | Pankaj Thakur |
First Address | Fredericktown, PA 15333-2114 |
Second Address | Washington, PA 15301-4062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 27/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014582 | MEDICARE (01) | PA |
1007288440104 | (05) | PA |
MD443133 | FELLOW-UPMC (01) | PA |