Provider Demographics
NPI:1275599649
Name:SHUKLA, VIKRAM RASIKLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:RASIKLAL
Last Name:SHUKLA
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 1:839 MAJESTIC CT
Mailing Address - Street 2:SUITE #8
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5147
Mailing Address - Country:US
Mailing Address - Phone:704-868-8988
Mailing Address - Fax:704-868-9948
Practice Address - Street 1:839 MAJESTIC CT
Practice Address - Street 2:SUITE #8
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5147
Practice Address - Country:US
Practice Address - Phone:704-868-8988
Practice Address - Fax:704-868-9948
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC333042084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8976031Medicaid
NCC65104Medicare UPIN
NC8976031Medicaid