Healthcare Provider Details

I. General information

NPI: 1265491310
Provider Name (Legal Business Name): LAKUMA R MOGILI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-8000
  • Fax: 540-536-7681
Mailing address:
  • Phone: 540-536-8000
  • Fax: 540-536-7681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101236421
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: