1073518494 NPI number — VENUGOPAL NAIDU GADIPUDI M.D.

Table of content: VENUGOPAL NAIDU GADIPUDI M.D. (NPI 1073518494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073518494 NPI number — VENUGOPAL NAIDU GADIPUDI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GADIPUDI
Provider First Name:
VENUGOPAL
Provider Middle Name:
NAIDU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073518494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1689
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ETOWAH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28729-1689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-891-5524
Provider Business Mailing Address Fax Number:
828-891-4069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 VILLAGE DR
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28304-3811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-484-0029
Provider Business Practice Location Address Fax Number:
910-484-0275
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  200400863 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 561775962 . This is a "COMMERICAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 891375A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13754A . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561775962 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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