Healthcare Provider Details

I. General information

NPI: 1801883913
Provider Name (Legal Business Name): LAKSHMI KODE SAMMARCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAKSHMI KODE SAMMARCO MD

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4795 DRAKE RD
CINCINNATI OH
45243-4119
US

IV. Provider business mailing address

4795 DRAKE RD
CINCINNATI OH
45243-4119
US

V. Phone/Fax

Practice location:
  • Phone: 513-213-9330
  • Fax: 877-766-4557
Mailing address:
  • Phone: 513-213-9330
  • Fax: 877-766-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35058809
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number35058809
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: