Healthcare Provider Details

I. General information

NPI: 1225125800
Provider Name (Legal Business Name): LAKSHMI RAJESWARI VEMULAPALLI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HOLLAND ST LAKE ERIE WOMENS CENTER
ERIE PA
16507
US

IV. Provider business mailing address

202 BAYNIST DRIVE
ERIE PA
16505
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-5058
  • Fax:
Mailing address:
  • Phone: 814-833-8140
  • Fax: 814-452-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD025794E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: