Healthcare Provider Details

I. General information

NPI: 1063468809
Provider Name (Legal Business Name): LAKSHMAN RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 E H ST
ERWIN NC
28339-2209
US

IV. Provider business mailing address

518 E H ST
ERWIN NC
28339-2209
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-4551
  • Fax: 910-897-2218
Mailing address:
  • Phone: 910-897-4551
  • Fax: 910-897-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number32276
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32276
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: