1801883913 NPI number — LAKSHMI KODE SAMMARCO MD

Table of content: LAKSHMI KODE SAMMARCO MD (NPI 1801883913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801883913 NPI number — LAKSHMI KODE SAMMARCO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KODE SAMMARCO
Provider First Name:
LAKSHMI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMMARCO
Provider Other First Name:
LAKSHMI
Provider Other Middle Name:
KODE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801883913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4795 DRAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45243-4119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-213-9330
Provider Business Mailing Address Fax Number:
877-766-4557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4795 DRAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45243-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-213-9330
Provider Business Practice Location Address Fax Number:
877-766-4557
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35058809 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085N0700X , with the licence number: 35058809 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0229363 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110985000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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