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General NPI Number Information
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NPI Number | 1285830323
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Entity Type | Individual
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Provider Name | PRANJAL THAKURIA MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 150 E MANNING ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-5109
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Country | US
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Telephone | 401-272-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E MANNING ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-5109
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Country | US
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Telephone | 216-288-6940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2009-00806
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 57.009639
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD60157794
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD14427
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License Number State | RI
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