Provider Demographics
NPI:1457446312
Name:LAKSHMAN, VENKATESH (MD)
Entity Type:Individual
Prefix:
First Name:VENKATESH
Middle Name:
Last Name:LAKSHMAN
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 1:3520 AIRPORT BLVD NW STE F
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8674
Mailing Address - Country:US
Mailing Address - Phone:252-206-5622
Mailing Address - Fax:252-206-5623
Practice Address - Street 1:3520 AIRPORT BLVD NW
Practice Address - Street 2:STE F
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8674
Practice Address - Country:US
Practice Address - Phone:252-206-5622
Practice Address - Fax:252-206-5623
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500073207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1388COtherBCBS
NC7407289OtherAETNA
NC193133OtherMEDCOST
NC5900445Medicaid
NC510600219OtherCIGNA
NC193133OtherMEDCOST
NC1388COtherBCBS