MEDICARE: YOGENDRA K. THAKER M.D.

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	71439	MA

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	:	1558358135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOGENDRA K. THAKER M.D.

Provider Business Mailing Address
First Line	:	80 MECHANIC ST
Second Line	:
City	:	ATHOL
State	:	MA
Zip	:	01331-3534
Country	:	US
Telephone Number	:	978-249-2347
Fax Number	:	978-249-6333

Provider Business Practice Location Address
First Line	:	80 MECHANIC ST
Second Line	:
City	:	ATHOL
State	:	MA
Zip	:	01331-3534
Country	:	US
Telephone Number	:	978-249-2347
Fax Number	:	978-249-6333

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	11/04/2010

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