Basic Information
| Provider Information | |||||||||
| NPI: | 1508874470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAKAR | ||||||||
| FirstName: | HIMAL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LAL | ||||||||
| OtherFirstName: | HIMAL | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1625 STRAITS TPKE | ||||||||
| Address2: | SUITE #201 | ||||||||
| City: | MIDDLEBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067621836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035739512 | ||||||||
| FaxNumber: | 2035682904 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 ROBBINS ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035736263 | ||||||||
| FaxNumber: | 2035736030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 2004033200 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 208M00000X | 046713 | CT | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 198531 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 7614689 | 01 | AETNA | OTHER | 207313305 | 05 | MO | MEDICAID | 704270 | 01 | HEALTHLINK | OTHER |