Provider Demographics
NPI:1083682298
Name:LAKSHMINRUSIMHA, SATYANARAYANA (MD)
Entity Type:Individual
Prefix:
First Name:SATYANARAYANA
Middle Name:
Last Name:LAKSHMINRUSIMHA
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 1:1400 SWEET HOME RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2777
Mailing Address - Country:US
Mailing Address - Phone:716-932-6064
Mailing Address - Fax:716-932-6076
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2503462080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000525820001OtherBC/BS
NY01982365Medicaid
00020529801OtherUNIVERA
3610852OtherIHA
040426001787OtherFIDELIS
000525820001OtherBC/BS