Healthcare Provider Details

I. General information

NPI: 1619922192
Provider Name (Legal Business Name): LALITHA KODURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE STE 220
JOHNSTON RI
02919-3278
US

IV. Provider business mailing address

53 OLD RIVER RD
LINCOLN RI
02865-1307
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-1900
  • Fax: 401-453-3049
Mailing address:
  • Phone: 401-333-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD12101
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: