Individual
DR. LAVANYA KODALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1500 N JAMES ST, ROME, NY 13440-2844
(153) 387-0003
Mailing address
PO BOX 2005, EAST SYRACUSE, NY 13057-4505
(315) 449-0513
(315) 362-5120
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
231455
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033579
ANTHEM
VA
05
—
04193115
—
NY
05
—
1518058569
—
VA
01
—
293961
AMERIGROUP
VA
01
—
484645
NCPPO
VA
01
—
9385084
PHCS
VA
01
—
K142-0001
CAREFIRST 2005
VA
Enumeration date
09/27/2006
Last updated
12/26/2024
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