Healthcare Provider Details

I. General information

NPI: 1932383320
Provider Name (Legal Business Name): LAKSHMI A. MADDURU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAKSHMI ANISINGARAJU M.D.

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

800 PLAZA DR SUITE 230
BELLE VERNON PA
15012-4019
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax:
Mailing address:
  • Phone: 724-379-4011
  • Fax: 724-379-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24167
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD433112
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD433112
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1013282
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: