Healthcare Provider Details

I. General information

NPI: 1528476215
Provider Name (Legal Business Name): GAYATRI LESSEY MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2014
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8926 WOODYARD RD STE 602
CLINTON MD
20735-4235
US

IV. Provider business mailing address

4610 KANAWHA AVE SW STE 402
SOUTH CHARLESTON WV
25309-1367
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-9414
  • Fax: 301-868-6055
Mailing address:
  • Phone: 304-400-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101279078
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0097366
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number28865
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: