Basic Information
| Provider Information | |||||||||
| NPI: | 1992968960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEENAKSHISUNDARAM | ||||||||
| FirstName: | LAKSHMI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 EXECUTIVE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212281762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104022379 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 MAIDEN CHOICE LN | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102475602 | ||||||||
| FaxNumber: | 4102421756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD434638 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D0074139 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.