Individual
GAUTAM C THAKUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
751 LIBERTY ST, MEADVILLE, PA 16335-2559
(814) 333-5144
(814) 373-2255
Mailing address
PO BOX 1420, CLEARFIELD, PA 16830-5420
(877) 235-7686
(814) 235-1566
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD061648L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016368510004
—
PA
Enumeration date
06/06/2006
Last updated
02/24/2020
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