Provider Demographics
NPI:1245224450
Name:VYTHILINGAM, LAKSHMY MATHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMY
Middle Name:MATHUR
Last Name:VYTHILINGAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1611 MOUNTAIN SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4154
Mailing Address - Country:US
Mailing Address - Phone:718-801-1770
Mailing Address - Fax:
Practice Address - Street 1:2430 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3553
Practice Address - Country:US
Practice Address - Phone:575-887-4504
Practice Address - Fax:575-628-5080
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227213208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02131919Medicaid
NYH32120Medicare UPIN
NY02131919Medicaid