DR. LAKSHMI MUDUNURI (NPI# 1508847823) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508847823 |
| Entity Type | Individual |
| Full Name | DR. LAKSHMI MUDUNURI |
| Credential | M.D. |
| Practice Address |
170 Governors Ave Medford MA 02155-1643 |
| Mailing Address |
33 Bellis Cir Cambridge MA 02140-3207 |
| Practice Telephone | 7813066163 |
| Practice Fax Number | 7813066146 |
| Mailing Telephone | 7813066163 |
| Mailing Fax Number | 7813066146 |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2011-05-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0805X |
Psychiatry & Neurology Specialization: Geriatric Psychiatry |
58025 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | BCBS | J06711 | 01 |
| MA | 3027350 | 05 | |
| MA | EVERCARE | 15-80089 | 01 |
| TUFTS | 058025 | 01 |
| Street Address |
170 GOVERNORS AVE |
| City | MEDFORD |
| State | MA |
| Zip Code | 02155-1643 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841290467 | Melrosewakefield Healthcare, Inc. | General Acute Care Hospital | 170 Governors Ave, Medford, MA 02155-1643 | 2005-07-26 |
| 1255964391 | Hallmark Health Medical Associates Inc | Psychologist | 170 Governors Ave, Medford, MA 02155-1643 | 2020-02-18 |
| 1205473592 | Melrosewakefield Healthcare, Inc. | Clinic/Center | 170 Governors Ave, Medford, MA 02155-1643 | 2019-12-05 |
| 1801431754 | John Norcross | Occupational Therapist | 170 Governors Ave, Medford, MA 02155-1643 | 2019-11-14 |
| 1770029670 | Kayla Rose | Registered Nurse | 170 Governors Ave, Medford, MA 02155-1643 | 2017-01-16 |
| 1326403809 | Ying Ma | Nurse Practitioner | 170 Governors Ave, Medford, MA 02155-1643 | 2015-12-28 |
| 1396143624 | Laurie Young | Nurse Practitioner | 170 Governors Ave, Medford, MA 02155-1643 | 2014-12-19 |
| 1912325754 | Yesodarao and Associates LLC | Internal Medicine | 170 Governors Ave, Medford, MA 02155-1643 | 2014-03-30 |
| 1124364872 | Andrea Messina | Nurse Practitioner | 170 Governors Ave, Medford, MA 02155-1643 | 2012-12-28 |
| 1124362389 | Michelle Vidal | Social Worker | 170 Governors Ave, Lawrence Memorial Hospital, Medford, MA 02155-1643 | 2012-11-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679113922 | Elena Chapman | Nurse Practitioner | 293 Salem St 4, Medford, MA 02155 | 2020-01-14 |
| 1922658830 | Michelle Anne Zona | Counselor | 100 George Hassett Dr, Medford, MA 02155 | 2019-09-13 |
| 1487138509 | Dava Davainis | Social Worker | 76 Newbern Avenue, Apt. 1, Medford, MA 02155 | 2018-09-25 |
| 1265915128 | Erin Roberts | Counselor | Medford Public Schools, 3002 Mystic Valley Pkwy, Medford, MA 02155 | 2018-09-07 |
| 1871075739 | Janice Madeline Cole | Social Worker | 3820 Mystic Valley Pkwy Unit 805, Medford, MA 02155 | 2018-09-06 |
| 1447732573 | Mystick Women's Health, Inc. | Obstetrics & Gynecology | 13 Bradlee Road, Medford, MA 02155 | 2018-09-05 |
| 1144713090 | Laura Rogers | Psychologist | 203 Paige Hall, 12 Upper Campus Road, Medford, MA 02155 | 2018-06-14 |
| 1871086694 | Shuo Yang | Dentist | 8 9th St Apt 310, Medford, MA 02155 | 2018-06-07 |
| 1891287108 | Xuhua Qin | Psychologist | 120 Curtis Street, Medford, MA 02155 | 2018-06-01 |
| 1568953529 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 471 Salem St, Medford, MA 02155 | 2018-05-25 |
| Find all providers in zip 02155 | ||||
| Taxonomy Code | 2084P0805X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Geriatric Psychiatry |
| Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881882082 | David R. Mccomb, Do, LLC | Psychiatry & Neurology | 239 Taunton Blvd, A-2, Medford, NJ 08055-3471 | 2007-10-12 |
| 1417921925 | David S Harnett | Psychiatry & Neurology | 170 Governors Ave, 1st Floor, Medford, MA 02155-1643 | 2006-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629384995 | Aaron Koenig | Psychiatry & Neurology | 178 Oakland St, Wellesley, MA 02481-5323 | 2010-08-25 |
| 1649306077 | Mark I. Frankel | Psychiatry & Neurology | 148 Linden St Ste 109, Wellesley, MA 02482-7916 | 2007-02-27 |
| 1790850410 | Sorgi Associates, PC | Psychiatry & Neurology | 142 North Rd Ste F105, Sudbury, MA 01776-1142 | 2006-11-21 |
| 1316958093 | Moak Geriatric Psychiatry | Psychiatry & Neurology | 5206 Union St Bldg 500, Westborough, MA 01581-5418 | 2006-08-10 |
| 1285670471 | Merrimack Psychiatric Associates, PC | Psychiatry & Neurology | Merrimack Valley Hospital, Abu, 140 Lincoln Ave, Haverhill, MA 01830 | 2006-06-22 |
| 1346281961 | Bruce Kaster | Psychiatry & Neurology | 60 Kendrick St, Ste 204, Needham, MA 02494-2726 | 2006-06-08 |
| 1831149244 | John Stuart Looper | Psychiatry & Neurology | 122 Ward St, Chestnut Hill, MA 02467-1029 | 2006-05-10 |
| 1619939287 | Katharine Poole Wolf | Psychiatry & Neurology | 521 Mt Auburn St, Ste 109, Watertown, MA 02472 | 2006-04-06 |
| 1437137346 | Robert B Portney | Psychiatry & Neurology | 6 Hearthstone Pl, Andover, MA 01810-5421 | 2006-01-03 |
| 1457342420 | Samir Pravinchandra Patel | Psychiatry & Neurology | 365 East St, Tewksbury, MA 01876-1950 | 2005-10-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.