Provider Demographics
NPI:1043293715
Name:LAKHANPAL, SURESH K (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:K
Last Name:LAKHANPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-1828
Mailing Address - Country:US
Mailing Address - Phone:706-653-1088
Mailing Address - Fax:706-653-1162
Practice Address - Street 1:417 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1943
Practice Address - Country:US
Practice Address - Phone:706-653-1088
Practice Address - Fax:706-653-1162
Is Sole Proprietor?:No
Enumeration Date:2005-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA455282085R0202X
GA0455282085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52651517 008OtherBCBS
GA52651517 008OtherBCBS
GA30BDMJBMedicare ID - Type Unspecified