Provider Demographics
NPI:1588852172
Name:DONTU, VIJAYA S (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:S
Last Name:DONTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-4005
Mailing Address - Fax:717-812-2495
Practice Address - Street 1:1001 S GEORGE ST FL 4
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD434227207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1569319OtherGATEWAY-WMG
PA2038807OtherHIGHMARK BLUE SHIELD
PA30103495OtherAMERIHEALTH MERCY-WMG
PA20090419OtherAMERIHEALTH MERCY-WMG
PA50077532OtherCAPITAL BLUE CROSS-WMG
PA102121474Medicaid
PA9111163OtherAETNA
PA209952OtherJOHNS HOPKINS
MD033819200Medicaid
PA117792OtherGEISINGER HEALTH PLAN
MD927815-01OtherCAREFIRST MD BCBS
PA30131835OtherAMERIHEALTH MERCY - WMG
PA117792OtherGEISINGER HEALTH PLAN
PA20090419OtherAMERIHEALTH MERCY-WMG