=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699806596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASHVANTLAL K. THAKKAR, M. D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 LAIDLEY ST SUITE 208
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25301-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-342-8579
-----------------------------------------------------
Fax | 304-342-8273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3739
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25337-3739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-342-8579
-----------------------------------------------------
Fax | 304-342-8273
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING CLERK
-----------------------------------------------------
Name | SARAH LEA HITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-342-8579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 17226
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------