Provider Demographics
NPI:1831299783
Name:SHUKLA, PADMA KANT (MD FACP FACC)
Entity Type:Individual
Prefix:DR
First Name:PADMA
Middle Name:KANT
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD FACP FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE #210
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-481-6999
Mailing Address - Fax:703-437-1101
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE #210
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-481-6999
Practice Address - Fax:703-437-1101
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101038073207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6096018Medicaid
VA6096018Medicaid