Individual
PUSHPA T. THAKARAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
902 MADISON DR, MALVERN, PA 19355-3101
(610) 647-0591
(610) 647-2448
Mailing address
902 MADISON DR, MALVERN, PA 19355-3101
(610) 647-0591
(610) 647-2448
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
MD-018899-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06516660004
—
PA
Enumeration date
07/23/2006
Last updated
07/08/2007
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