Provider Demographics
NPI:1245798123
Name:ASHOK, VIVEK ANIRUDH (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:ANIRUDH
Last Name:ASHOK
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 1:1700 S BROAD ST APT 301
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2340
Mailing Address - Country:US
Mailing Address - Phone:703-597-2567
Mailing Address - Fax:
Practice Address - Street 1:1700 S BROAD ST APT 301
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2340
Practice Address - Country:US
Practice Address - Phone:703-597-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481647208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program