Provider Demographics
NPI:1053410910
Name:THAKKAR, HARISH N (MD)
Entity type:Individual
Prefix:MR
First Name:HARISH
Middle Name:N
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:P. O. BOX 11124
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4002
Mailing Address - Country:US
Mailing Address - Phone:281-933-9304
Mailing Address - Fax:281-933-9305
Practice Address - Street 1:16959 SOUTHWEST FWY STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3481
Practice Address - Country:US
Practice Address - Phone:281-903-7019
Practice Address - Fax:832-886-4729
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142109105Medicaid
TX8A9856Medicare PIN