Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 1.063425-RES | CT |
N | 111NI0900X | Internist | 1.063425-RES | CT |
Y | 207R00000X | Internist | 1.066404 | CT |
Y | 111NI0900X | Internist | 1.066404 | CT |
N | 207RC0200X | Critical Care Medicine | 1.063425-RES | CT |
N | 207RP1001X | Pulmonary Disease | 1.063425-RES | CT |
NPI | 1023450988 |
---|---|
Provider Name | Sanket Rajendrakumar Thakore |
First Address | New Haven, CT 06519-1612 |
Second Address | New Haven, CT 06510-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2013 |
Last Update Date | 09/09/2020 |