Provider Demographics
NPI:1629036595
Name:SASTRY, LAKSHMI S (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:S
Last Name:SASTRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19735 GERMANTOWN ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:301-917-6513
Mailing Address - Fax:301-917-6506
Practice Address - Street 1:10215 FERNWOOD ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-493-4440
Practice Address - Fax:301-493-9778
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG98279Medicare UPIN
G98279Medicare UPIN