Healthcare Provider Details

I. General information

NPI: 1265614622
Provider Name (Legal Business Name): LOKESH GOWDA B NANJUNDA GOWDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N POINTE BLVD
LANCASTER PA
17601-4132
US

IV. Provider business mailing address

802 NEW HOLLAND AVE SUITE 200
LANCASTER PA
17602-2287
US

V. Phone/Fax

Practice location:
  • Phone: 717-291-0700
  • Fax: 717-207-8626
Mailing address:
  • Phone: 717-291-0700
  • Fax: 717-358-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD437455
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD437455
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD437455
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: