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General NPI Number Information
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NPI Number | 1053582478
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Entity Type | Organization
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Legal Business Name | JYOTHI GADDE MD PA
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 3700 JOSEPH SIEWICK DR STE 304
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City | FAIRFAX
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State | VA
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Zip | 22033-1744
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Country | US
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Telephone | 703-648-0015
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Fax | 703-648-0047
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Provider Business Mailing Address
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Address Line | 493 BLACKWELL ROAD STE 305
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City | WARRENTON
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State | VA
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Zip | 20186-2628
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Country | US
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Telephone | 540-428-1715
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Fax | 540-428-1716
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Authorized Official
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Title or Position | OWNER
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Name | JYOTHI GADDE
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Credential | MD
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Telephone | 540-428-1715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101056351
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License Number State | VA
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