MEDICARE: DR. VIJAY LAKSHMI CHOUDHRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD-065597L	PA

General Provider Information

NPI Number	:	1639283062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIJAY LAKSHMI CHOUDHRY M.D.

Provider Business Mailing Address
First Line	:	41 UNIVERSITY DR STE 106
Second Line	:
City	:	NEWTOWN
State	:	PA
Zip	:	18940-1873
Country	:	US
Telephone Number	:	215-710-2930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 ISLAND AVE STE D&E
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-2300
Country	:	US
Telephone Number	:	215-863-6110
Fax Number	:	215-963-6110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/21/2022

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