Provider Demographics
NPI:1124748504
Name:YOGENDRA K THAKER M.D.
Entity type:Organization
Organization Name:YOGENDRA K THAKER M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOGENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-407-1975
Mailing Address - Street 1:20 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01331-9787
Mailing Address - Country:US
Mailing Address - Phone:978-249-2347
Mailing Address - Fax:978-249-6333
Practice Address - Street 1:20 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILLIPSTON
Practice Address - State:MA
Practice Address - Zip Code:01331-9787
Practice Address - Country:US
Practice Address - Phone:978-249-2347
Practice Address - Fax:978-249-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty