Provider Demographics
NPI:1548503543
Name:DESAI, LEKHA KOPPOLU (MD)
Entity type:Individual
Prefix:
First Name:LEKHA
Middle Name:KOPPOLU
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEKHA
Other - Middle Name:KOPPOLU
Other - Last Name:MUKKAMALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4414 LAKE BOONE TRL STE 302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7514
Mailing Address - Country:US
Mailing Address - Phone:919-782-8038
Mailing Address - Fax:
Practice Address - Street 1:4414 LAKE BOONE TRL STE 302
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7514
Practice Address - Country:US
Practice Address - Phone:919-782-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148705207W00000X
NJ25MA10541500207WX0107X
390200000X
NC2024-01714207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program