Healthcare Provider Details

I. General information

NPI: 1053303891
Provider Name (Legal Business Name): LAKSHMI VADLAMUDI GORDON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 VALLEYGATE DR STE. 201
FAYETTEVILLE NC
28304-3688
US

IV. Provider business mailing address

PO BOX 87306
FAYETTEVILLE NC
28304-7306
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-9020
  • Fax: 910-484-9012
Mailing address:
  • Phone: 910-484-9020
  • Fax: 910-484-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: