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NPI Code Detail

MEDICARE: ROBERT K THACKER MD

MEDICARE: ROBERT K THACKER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician20635NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
36016OTHERNCPARTNERS MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182445OTHERNCBCBS OF NC
231673OTHERNCMEDCOST
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306926621
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT K THACKER MD
Provider Business Mailing Address
First Line : PO BOX 14883
Second Line :
City : GREENSBORO
State : NC
Zip : 27415-4883
Country : US
Telephone Number : 336-294-6190
Fax Number : 336-294-6278
Provider Business Practice Location Address
First Line : 1510 NC HIGHWAY 68 N
Second Line :
City : OAK RIDGE
State : NC
Zip : 27310-9733
Country : US
Telephone Number : 336-644-0111
Fax Number : 336-268-3119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 04/23/2021

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