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General NPI Number Information
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NPI Number | 1902283013
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Entity Type | Individual
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Provider Name | VAMSEE MOHANA LAKKAKULA M.D
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Gender | Male
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 111 MEDICAL PKWY FL 2
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0302
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Country | US
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Telephone | 757-312-4047
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Fax | 757-410-0339
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Provider Business Mailing Address
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Address Line | 111 MEDICAL PKWY FL 2
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0302
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Country | US
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Telephone | 757-312-4047
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Fax | 757-410-0339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 310853
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2023-02240
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101283205
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License Number State | VA
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