Healthcare Provider Details

I. General information

NPI: 1639283062
Provider Name (Legal Business Name): VIJAY LAKSHMI CHOUDHRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/21/2022
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 ISLAND AVE STE D&E
PHILADELPHIA PA
19153-2300
US

IV. Provider business mailing address

41 UNIVERSITY DR STE 106
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 215-863-6110
  • Fax: 215-963-6110
Mailing address:
  • Phone: 215-710-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-065597L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: