Provider Demographics
NPI:1942416763
Name:SHANKAR, KALA (MD)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:SHANKAR
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 1:101 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3324
Mailing Address - Country:US
Mailing Address - Phone:732-363-6655
Mailing Address - Fax:732-901-0277
Practice Address - Street 1:101 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3324
Practice Address - Country:US
Practice Address - Phone:732-363-6655
Practice Address - Fax:732-363-6656
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA80380207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA80380OtherLICENSE
111119SGDMedicare PIN
NJMA80380OtherLICENSE