MEDICARE: SRI LAKSHMI JASTHY MD

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	207R00000X	Internal Medicine Physician	MD425326	PA
2	207RH0003X	Hematology & Oncology Physician	MD425326	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1821230210	OTHER		NPI

General Provider Information

NPI Number	:	1821230210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRI LAKSHMI JASTHY MD

Provider Business Mailing Address
First Line	:	401 N MAIN ST
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349-8801
Country	:	US
Telephone Number	:	910-296-8880
Fax Number	:	910-296-2700

Provider Business Practice Location Address
First Line	:	401 N MAIN ST
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349-8801
Country	:	US
Telephone Number	:	910-296-8880
Fax Number	:	910-296-2700

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

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	01/07/2022

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