Healthcare Provider Details

I. General information

NPI: 1912136227
Provider Name (Legal Business Name): SEJAL THAKOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 BROADWAY
RAYNHAM MA
02767-1942
US

IV. Provider business mailing address

680 CENTRE ST
BROCKTON MA
02302-3308
US

V. Phone/Fax

Practice location:
  • Phone: 508-894-0400
  • Fax: 508-941-6446
Mailing address:
  • Phone: 508-894-0412
  • Fax: 508-941-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE 7608
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62820
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1025416
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: