Provider Demographics
NPI:1639673445
Name:LOCKE, DEVIKA
Entity Type:Individual
Prefix:
First Name:DEVIKA
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEVIKA
Other - Middle Name:
Other - Last Name:BAXI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3550 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3329
Mailing Address - Country:US
Mailing Address - Phone:215-590-2178
Mailing Address - Fax:215-590-4619
Practice Address - Street 1:3550 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3329
Practice Address - Country:US
Practice Address - Phone:215-590-2178
Practice Address - Fax:215-590-4619
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD472468208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics