Provider Demographics
NPI:1467402057
Name:SHUKLA, MANJUL (MD)
Entity Type:Individual
Prefix:
First Name:MANJUL
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-595-2300
Mailing Address - Fax:508-853-5226
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-595-2300
Practice Address - Fax:508-853-5226
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherONE HEALTH PLAN
AA1250OtherHARVARD PILGRIM HLTHCARE
B01040OtherBLUE SHIELD HMO BLUE
1061411OtherFIRST HEALTH
9773216OtherCIGNA HEALTH PLAN
B01040OtherBLUE CARE ELECT
0401702OtherEVERCARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
9900237OtherFALLON COMM HEALTH PLAN
B01040OtherBLUE SHIELD INDEMNITY
MA0178322Medicaid
27075OtherCHILDRENS MED SECUR PLAN
7432340OtherUS HEALTHCARE
784196OtherMVP HEALTH CARE
0174196OtherMEDICAID WELFARE
27075OtherHEALTHY START
7432340OtherAETNA
7432340OtherAETNA
B01040Medicare ID - Type UnspecifiedMEDICARE B
B01040OtherBLUE SHIELD HMO BLUE