Healthcare Provider Details

I. General information

NPI: 1871710756
Provider Name (Legal Business Name): NIKHIL A THAKUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 TURNPIKE ST SUITE 11
NORTH ANDOVER MA
01845-5924
US

IV. Provider business mailing address

575 TURNPIKE ST SUITE 11
NORTH ANDOVER MA
01845-5924
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-1946
  • Fax: 978-975-3925
Mailing address:
  • Phone: 978-794-1946
  • Fax: 978-975-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number261758
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number16927
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: