Provider Demographics
NPI:1134108236
Name:GANGA, LAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:GANGA
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 1:8210 LOUISIANA BLVD. NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1761
Mailing Address - Country:US
Mailing Address - Phone:505-858-1222
Mailing Address - Fax:505-858-1224
Practice Address - Street 1:8210 LOUISIANA BLVD. NE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1761
Practice Address - Country:US
Practice Address - Phone:505-858-1222
Practice Address - Fax:505-858-1224
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM81196207RG0300X
NM81-196207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11981Medicaid
349533501Medicare PIN
D35645Medicare UPIN
NM11981Medicaid
NM349533501Medicare PIN