Provider Demographics
NPI:1902283013
Name:LAKKAKULA, VAMSEE MOHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:VAMSEE
Middle Name:MOHANA
Last Name:LAKKAKULA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-1074
Mailing Address - Fax:704-316-1077
Practice Address - Street 1:14035 GRANDIFLORA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-8456
Practice Address - Country:US
Practice Address - Phone:704-316-1074
Practice Address - Fax:704-316-1077
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2023-02240207RC0000X
NY310853207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease