Healthcare Provider Details

I. General information

NPI: 1558711606
Provider Name (Legal Business Name): NAVEEN KUMAR GUMMADI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date: 02/02/2017
Reactivation Date: 03/15/2017

III. Provider practice location address

500 GYPSY LANE
YOUNGSTOWN OH
44501
US

IV. Provider business mailing address

500 GYPSY LANE
YOUNGSTOWN OH
44501
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-4250
  • Fax: 330-884-0651
Mailing address:
  • Phone: 330-884-4250
  • Fax: 330-884-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2018-0819
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: