MEDICARE: DR. SEETHA LAKSHMANAN 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	LP04444	RI
2	207RG0100X	Gastroenterology Physician	101487	GA

General Provider Information

NPI Number	:	1972099463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEETHA LAKSHMANAN MD

Provider Business Mailing Address
First Line	:	825 CHALKSTONE AVE
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-4728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2770
Country	:	US
Telephone Number	:	401-737-7000
Fax Number	:

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

Provider Enumeration Date	:	07/08/2018
Last Update Date	:	08/28/2024

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