Healthcare Provider Details

I. General information

NPI: 1396239281
Provider Name (Legal Business Name): THOMAS JAYAN ALUKAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

504 S LANSDOWNE AVE APT C08
YEADON PA
19050-2420
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-4684
  • Fax:
Mailing address:
  • Phone: 215-980-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101270880
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT214988
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: