Basic Information
| Provider Information | |||||||||
| NPI: | 1316391311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAKKAR | ||||||||
| FirstName: | BADAL | ||||||||
| MiddleName: | GIRISHBHAI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 BERGEN ST | ||||||||
| Address2: | UH-I-248 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739726056 | ||||||||
| FaxNumber: | 9739723129 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 W BELVEDERE AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212155216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106010594 | ||||||||
| FaxNumber: | 4106010939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2016 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | D86885 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.