Healthcare Provider Details

I. General information

NPI: 1508489527
Provider Name (Legal Business Name): LAKSHMI RAVINDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 CAMERON VALLEY PKWY FL 4
CHARLOTTE NC
28211-4369
US

IV. Provider business mailing address

4525 CAMERON VALLEY PKWY FL 4
CHARLOTTE NC
28211-4369
US

V. Phone/Fax

Practice location:
  • Phone: 704-468-8876
  • Fax:
Mailing address:
  • Phone: 704-468-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2026-03047
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: