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1437151453

NPI Code Detail

MEDICARE: DR. JONATHAN DAVID THACKERAY MD

MEDICARE: DR. JONATHAN DAVID THACKERAY 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
1	208000000X	Pediatrics Physician	35.083628	OH
2	2080C0008X	Child Abuse Pediatrics Physician	35.083628	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437151453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN DAVID THACKERAY MD

Provider Business Mailing Address
First Line	:	PO BOX 933432
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0039
Country	:	US
Telephone Number	:	937-641-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CHILDRENS PLZ
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-1815
Country	:	US
Telephone Number	:	937-641-4000
Fax Number	:	937-641-3918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/12/2023

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Directions to “ DR. JONATHAN DAVID THACKERAY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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