Provider Demographics
NPI:1164445029
Name:THANKI, ASHOKKUMAR SHIVSHANKAR (MD)
Entity Type:Individual
Prefix:
First Name:ASHOKKUMAR
Middle Name:SHIVSHANKAR
Last Name:THANKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-0813
Mailing Address - Country:US
Mailing Address - Phone:215-752-4040
Mailing Address - Fax:215-752-5348
Practice Address - Street 1:3 CORNERSTONE DR
Practice Address - Street 2:STE 706
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1320
Practice Address - Country:US
Practice Address - Phone:215-752-4040
Practice Address - Fax:215-752-5348
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024365E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009470600001Medicaid
32094OtherAETNA
PA0021783000OtherKEYSTONE HEALTH PLAN EAST
32094OtherAETNA
PA0009470600001Medicaid