1033165964 NPI number — DR. KALYANI GADDIPATI M.D.

Table of content: DR. KALYANI GADDIPATI M.D. (NPI 1033165964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033165964 NPI number — DR. KALYANI GADDIPATI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GADDIPATI
Provider First Name:
KALYANI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1033165964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
917 RINEHART RD
Provider Second Line Business Mailing Address:
SUITE 2051
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-4802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-936-2444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
917 RINEHART RD
Provider Second Line Business Practice Location Address:
SUITE 2051
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-4802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-936-2444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2006

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: 207RG0100X , with the licence number:  ME74348 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5702044007 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43554 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100016196 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 254587000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3542 . This is a "FHHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2745785 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com