MEDICARE: LAKSHMI LAVANYA SODAGUM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	25MA07648000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	D08472200	OTHER	NJ	CDS

General Provider Information

NPI Number	:	1265421283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKSHMI LAVANYA SODAGUM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 535
Second Line	:
City	:	BUDD LAKE
State	:	NJ
Zip	:	07828-0535
Country	:	US
Telephone Number	:	973-579-5009
Fax Number	:	973-579-3009

Provider Business Practice Location Address
First Line	:	67 HIGH ST
Second Line	:	SUITE 102
City	:	NEWTON
State	:	NJ
Zip	:	07860-1705
Country	:	US
Telephone Number	:	973-579-5009
Fax Number	:	973-579-3009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/19/2026

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