Individual provider Active NPI

Lakshmana Rao Koneru, MD

  • Anesthesiology Physician
  • Buffalo, NY
National Provider Identifier
1083688170
Registry record updated Jul 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
1358381 Issued in NY
Practice address
565 Abbott Rd
Buffalo, NY 14220
Phone
(716) 826-6628
Fax
(716) 828-3448
NPI assigned
Feb 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 1358381 NY Primary

Addresses

Primary practice location

565 Abbott Rd
Buffalo, NY 14220

Mailing address

515 Abbott Rd
Ste 410
Buffalo, NY 14220
Phone (716) 826-6628

Other identifiers 1

IdentifierTypeStateIssuer
00609536MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101103001159 NY Practitioner - Anesthesiology 9739373721 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
1358381NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkside Medical Anesthesia Associates Anesthesiology CurrentSince Mar 1, 2023 Accepting new patients

Locations

3871 Harlem Rd
Ste 202
Buffalo, NY 14215

2157 Main St
Buffalo, NY 14214
Phone (716) 862-1501

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279238400000",
    "number": "1083688170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 ABBOTT RD",
            "address_2": "STE 410",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14220",
            "telephone_number": "716-826-6628",
            "fax_number": "716-828-3448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 ABBOTT RD",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14220",
            "telephone_number": "716-826-6628",
            "fax_number": "716-828-3448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONERU",
        "first_name": "LAKSHMANA",
        "middle_name": "RAO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2010-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "1358381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00609536",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.