Provider Demographics
NPI:1821011164
Name:REKHALA, VIJAY KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:KUMAR
Last Name:REKHALA
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 1:1774 MCCONNELL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-9300
Mailing Address - Country:US
Mailing Address - Phone:570-326-1283
Mailing Address - Fax:570-326-0391
Practice Address - Street 1:1705 WARREN AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2647
Practice Address - Country:US
Practice Address - Phone:570-326-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029239E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA432264OtherBLUE SHIELD
PA0009159600001Medicaid
PA0009159600001Medicaid
PA432264OtherBLUE SHIELD