Provider Demographics
NPI:1326120882
Name:NAGALLA, LAKSHMAN RAO (MD,)
Entity Type:Individual
Prefix:
First Name:LAKSHMAN RAO
Middle Name:
Last Name:NAGALLA
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 1:1331 BELFIORE WAY
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-8131
Mailing Address - Country:US
Mailing Address - Phone:407-810-3407
Mailing Address - Fax:
Practice Address - Street 1:1331 BELFIORE WAY
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-8131
Practice Address - Country:US
Practice Address - Phone:407-810-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79305207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260159100Medicaid
B04052Medicare UPIN
FL260159100Medicaid