Provider Demographics
NPI:1053303891
Name:GORDON, LAKSHMI VADLAMUDI (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:VADLAMUDI
Last Name:GORDON
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:PO BOX 87306
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7306
Mailing Address - Country:US
Mailing Address - Phone:910-484-9020
Mailing Address - Fax:910-484-9012
Practice Address - Street 1:2053 VALLEYGATE DR
Practice Address - Street 2:STE. 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-484-9020
Practice Address - Fax:910-484-9012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129MAMedicaid
NC89129MAMedicaid
NCH41786Medicare UPIN