Provider Demographics
NPI:1386603736
Name:GOGINENI, SREE LAKSHMI (MD)
Entity type:Individual
Prefix:DR
First Name:SREE
Middle Name:LAKSHMI
Last Name:GOGINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44121 LEESBURG PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5674
Mailing Address - Country:US
Mailing Address - Phone:703-255-6010
Mailing Address - Fax:703-255-6011
Practice Address - Street 1:2235 CEDAR LN STE 302
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5247
Practice Address - Country:US
Practice Address - Phone:703-255-6010
Practice Address - Fax:703-255-6011
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231808207RB0002X, 207R00000X, 2083B0002X
MDD0084486207RB0002X, 2083B0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2019536Medicaid
G01761C01OtherMEDICARE RAILROAD
DCG01761C01Medicare PIN
G01761C01OtherMEDICARE RAILROAD