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General NPI Number Information
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NPI Number | 1447612148
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Entity Type | Individual
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Provider Name | POONAM THAKORE M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 2800 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-4201
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Country | US
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Telephone | 475-210-5310
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Fax | 475-210-5784
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY HHC-CVO
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-5507
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Fax | 860-972-7040
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 62497
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036159517
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 036159517
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License Number State | IL
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