1396778437 NPI number — GOPAL REDDY GADE M.D. INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396778437 NPI number — GOPAL REDDY GADE M.D. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOPAL REDDY GADE M.D. INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1396778437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6183 N. FRESNO ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-261-0794
Provider Business Mailing Address Fax Number:
559-261-0797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6183 N FRESNO ST
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-8611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-261-0794
Provider Business Practice Location Address Fax Number:
559-261-0797
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBLES
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
559-261-0794

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  A35041 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A350410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com