Healthcare Provider Details

I. General information

NPI: 1609493584
Provider Name (Legal Business Name): LAKSHMI MENON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date: 01/17/2022
Reactivation Date: 05/04/2022

III. Provider practice location address

1198 S GOVERNORS AVE STE 100
DOVER DE
19904-6930
US

IV. Provider business mailing address

607 EAST ST UNIT 607
CAMDEN DE
19934-1385
US

V. Phone/Fax

Practice location:
  • Phone: 322-730-2734
  • Fax:
Mailing address:
  • Phone: 929-353-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC10028124
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: