Provider Demographics
NPI:1366443483
Name:URAGODA, LALITH C (MD)
Entity Type:Individual
Prefix:
First Name:LALITH
Middle Name:C
Last Name:URAGODA
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 1:2222 N NEVADA AVE STE 4004
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6832
Mailing Address - Country:US
Mailing Address - Phone:719-471-7064
Mailing Address - Fax:719-776-5459
Practice Address - Street 1:2222 N NEVADA AVE STE 4004
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6832
Practice Address - Country:US
Practice Address - Phone:719-471-7064
Practice Address - Fax:719-776-5459
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33441207RP1001X
CO50637207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY#000000512196OtherANTHEM PIN - CHS, INC.
IN200507380Medicaid
KY6434341100Medicaid
IN200507380Medicaid
KYP00406636Medicare PIN
IN249390Medicare PIN
G76469Medicare UPIN
KYP400025706Medicare PIN