Healthcare Provider Details

I. General information

NPI: 1720139843
Provider Name (Legal Business Name): LAKSHMI BABU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SCHOOL STREET
UNIONVILLE CT
06085
US

IV. Provider business mailing address

4 FARM SPRINGS RD
FARMINGTON CT
06032-2573
US

V. Phone/Fax

Practice location:
  • Phone: 860-675-1445
  • Fax: 860-675-1447
Mailing address:
  • Phone: 860-284-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number237772
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: