Healthcare Provider Details

I. General information

NPI: 1902595283
Provider Name (Legal Business Name): BIANCA THAKKAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5661
  • Fax: 860-224-5785
Mailing address:
  • Phone: 860-972-9093
  • Fax: 860-972-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84850
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: