Provider Demographics
NPI:1427074343
Name:THAKUR, MAGENDRA (MD)
Entity type:Individual
Prefix:
First Name:MAGENDRA
Middle Name:
Last Name:THAKUR
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 1:7957 US HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3239
Mailing Address - Country:US
Mailing Address - Phone:315-268-1644
Mailing Address - Fax:315-265-7736
Practice Address - Street 1:7957 US HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3239
Practice Address - Country:US
Practice Address - Phone:315-268-1644
Practice Address - Fax:315-265-7736
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187003207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01330116Medicaid
NY01330116Medicaid
F18849Medicare UPIN
NY55103BMedicare PIN