Healthcare Provider Details

I. General information

NPI: 1164532123
Provider Name (Legal Business Name): MONICA S THAKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

1100 FAIRVIEW AVE N M/S D5-280
SEATTLE WA
98109
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2106
  • Fax:
Mailing address:
  • Phone: 206-667-5160
  • Fax: 206-667-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number53919
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD00043871
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: