Provider Demographics
NPI:1477591345
Name:NANDIWADA, LAKSHMI P (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:P
Last Name:NANDIWADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2228
Mailing Address - Country:US
Mailing Address - Phone:908-216-6501
Mailing Address - Fax:732-294-2470
Practice Address - Street 1:24 PLAZA 9
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3010
Practice Address - Country:US
Practice Address - Phone:732-431-0505
Practice Address - Fax:732-294-2470
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5178100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3835804Medicaid