Healthcare Provider Details

I. General information

NPI: 1215007968
Provider Name (Legal Business Name): JHANSI LANKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 ALDERSON ST
WILLIAMSON WV
25661-3215
US

IV. Provider business mailing address

1476 FOREST HILLS RD
FOREST HILLS KY
41527-8333
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-2500
  • Fax: 304-235-4549
Mailing address:
  • Phone: 606-237-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20584
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: