Basic Information
| Provider Information | |||||||||
| NPI: | 1790701712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THAKUR | ||||||||
| FirstName: | RAJBALA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755982 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 604 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852755982 | ||||||||
| FaxNumber: | 5857560169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/18/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 199637 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 199637 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LH0002X | 199637 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01576021 | 05 | NY | MEDICAID | 058157 | 01 | NY | MVP PROVIDER | OTHER | 00040826601 | 01 | NY | UNIVERA | OTHER | 7152065 | 01 | NY | AETNA | OTHER | G0189393590 | 01 | NY | BLUE CHOICE GROUP | OTHER | P010199637 | 01 | NY | BLUE CHOICE PTC | OTHER | 199637-0 | 01 | NY | WORKER'S COMP | OTHER | 050059021 | 01 | NY | RAILROAD MEDICARE | OTHER | 5398992 | 01 | NY | GHI | OTHER | MDA531 | 01 | NY | PREFERRED CARE | OTHER | MDG079 | 01 | NY | PREFERRED CARE PTC | OTHER | G0189393590 | 01 | NY | BLUE CHOICE PTC GROUP | OTHER | 000912439001 | 01 | NY | BS WNY/HEALTHNOW | OTHER | 00040826602 | 01 | NY | UNIVERA PTC | OTHER | 2222 | 01 | NY | BLUE SHIELD GROUP | OTHER |