Healthcare Provider Details

I. General information

NPI: 1285559898
Provider Name (Legal Business Name): MR. VIKRANT THAKUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S EUTAW STREET 1ST FLOOR
BALTIMORE MD
21201-1606
US

IV. Provider business mailing address

16 S EUTAW STREET 1ST FLOOR
BAETIMORE MD
21201-1606
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5408
  • Fax: 410-328-8374
Mailing address:
  • Phone: 410-328-5408
  • Fax: 410-328-8374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: