MEDICARE: DR. LAKSHMI KALYANI KODEY 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	207Q00000X	Family Medicine Physician	MD449839	PA

General Provider Information

NPI Number	:	1508178427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAKSHMI KALYANI KODEY M.D.

Provider Business Mailing Address
First Line	:	30 HIGH ST
Second Line	:
City	:	ETNA
State	:	PA
Zip	:	15223-1954
Country	:	US
Telephone Number	:	412-782-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 HIGH ST
Second Line	:
City	:	ETNA
State	:	PA
Zip	:	15223-1954
Country	:	US
Telephone Number	:	412-782-6800
Fax Number	:

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	05/22/2014

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