Provider Demographics
NPI:1376532606
Name:DUKLE, VIJAYA (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:
Last Name:DUKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIJAYA
Other - Middle Name:
Other - Last Name:SHENAILANJEKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8500-4066
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2010 OLD W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:302-709-4497
Practice Address - Fax:302-733-0854
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072843L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA052762H12Medicare PIN