Provider Demographics
NPI:1124275334
Name:THAKER, NILAY BHASKER (DO)
Entity type:Individual
Prefix:DR
First Name:NILAY
Middle Name:BHASKER
Last Name:THAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 DAYBREAK CIRCLE
Mailing Address - Street 2:SUITE A150 PMB 263
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1638
Mailing Address - Country:US
Mailing Address - Phone:630-730-0302
Mailing Address - Fax:304-263-4991
Practice Address - Street 1:484 WILLIAMSPORT PIKE # 151
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-5707
Practice Address - Country:US
Practice Address - Phone:630-730-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022728207QA0505X
WV3634207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187277YTKHMedicare UPIN