Provider Demographics
NPI:1689630774
Name:COX, LAKSHMI KOLAGOTLA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:KOLAGOTLA
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAKSHMI
Other - Middle Name:
Other - Last Name:KOLAGOTLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:REVERE HEALTH CARE CENTER
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3675
Practice Address - Country:US
Practice Address - Phone:781-485-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA158336OtherTUFTS HEALTH PLAN
MAJ22476OtherBCBS MA
MA0125032Medicaid
MA0125032Medicaid
G59689Medicare UPIN