Healthcare Provider Details

I. General information

NPI: 1699858316
Provider Name (Legal Business Name): RADHIKA GOLLAPUDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 NORTH HIGH ST
COLUMBUS OH
43201
US

IV. Provider business mailing address

4070 OXFORD DRIVE UPPER ARLINLOA
COLUMBUS OH
43220
US

V. Phone/Fax

Practice location:
  • Phone: 614-299-6600
  • Fax:
Mailing address:
  • Phone: 614-326-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35074990
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35074990
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number350749904
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: