Healthcare Provider Details

I. General information

NPI: 1902853724
Provider Name (Legal Business Name): C.R. GAVVA MD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 S 4TH ST
TERRE HAUTE IN
47802-5507
US

IV. Provider business mailing address

3702 S 4TH ST
TERRE HAUTE IN
47802-5507
US

V. Phone/Fax

Practice location:
  • Phone: 812-234-0098
  • Fax: 812-234-3873
Mailing address:
  • Phone: 812-234-0098
  • Fax: 812-234-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANDRA GAVVA REDDY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 812-234-0098