Healthcare Provider Details

I. General information

NPI: 1700307956
Provider Name (Legal Business Name): DR. VENKATA LAKSHMI PRASANNA KOTAPATI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. VENKATA LAKSHMI PRASANNA MADDUKURI

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK ST
FARMVILLE VA
23901-1199
US

IV. Provider business mailing address

4904 MOUNTAIN LAUREL DR
LYNCHBURG VA
24503-1971
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5203
  • Fax:
Mailing address:
  • Phone: 914-826-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101268833
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101268833
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: