Individual
DR. LAKSHMI MUDUNURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
170 GOVERNORS AVE, MEDFORD, MA 02155-1643
(781) 306-6163
(781) 306-6146
Mailing address
33 BELLIS CIR, CAMBRIDGE, MA 02140-3207
(781) 306-6163
(781) 306-6146
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
58025
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058025
TUFTS
—
01
—
15-80089
EVERCARE
MA
05
—
3027350
—
MA
01
—
J06711
BCBS
MA
Enumeration date
11/14/2005
Last updated
05/19/2011
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