Provider Demographics
NPI:1316916505
Name:THAKKAR, MULJIBHAI J (MD)
Entity type:Individual
Prefix:DR
First Name:MULJIBHAI
Middle Name:J
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 GOVERNOR G.C. PEERY HWY
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-0279
Mailing Address - Country:US
Mailing Address - Phone:276-964-6649
Mailing Address - Fax:276-964-5007
Practice Address - Street 1:6719 GOVERNOR G.C. PEERY HWY
Practice Address - Street 2:SUITE 2600
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-0279
Practice Address - Country:US
Practice Address - Phone:276-964-6649
Practice Address - Fax:276-964-5007
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087219000Medicaid
VA011104800OtherFEDERAL BLACK LUNG PROGRAM
KY64661788Medicaid
VA1003658OtherUNITED MINE WORKERS ASSOCIATION
VA006088414Medicaid
VA060108OtherANTHEM
VA060108OtherANTHEM
VA006088414Medicaid
WV0087219000Medicaid
VA110008001Medicare PIN