Healthcare Provider Details

I. General information

NPI: 1508874470
Provider Name (Legal Business Name): HIMAL THAKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HIMAL LAL

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST 3RD FLOOR
WATERBURY CT
06708-2613
US

IV. Provider business mailing address

1625 STRAITS TPKE SUITE #201
MIDDLEBURY CT
06762-1836
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6263
  • Fax: 203-573-6030
Mailing address:
  • Phone: 203-573-9512
  • Fax: 203-568-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2004033200
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number046713
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: