Provider Demographics
NPI:1841451879
Name:SHUKLA, ANIL (MD)
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:
Last Name:SHUKLA
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 1:459 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902
Mailing Address - Country:US
Mailing Address - Phone:434-654-7150
Mailing Address - Fax:434-982-7147
Practice Address - Street 1:459 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902
Practice Address - Country:US
Practice Address - Phone:434-654-7150
Practice Address - Fax:434-982-7147
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA100974Medicare PIN