Provider Demographics
NPI:1396905048
Name:THAKARAR, KINNA (DO)
Entity type:Individual
Prefix:DR
First Name:KINNA
Middle Name:
Last Name:THAKARAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:100 GANNETT DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-523-3649
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:50 FODEN RD, STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1718
Practice Address - Country:US
Practice Address - Phone:207-774-5816
Practice Address - Fax:207-523-8594
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEDO24982083A0300X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400234326Medicare PIN