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General NPI Number Information
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NPI Number | 1174649362
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Entity Type | Organization
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Legal Business Name | JYOTHI GADDE M.D., P.A.
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 493 BLACKWELL RD 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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Provider Business Mailing Address
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Address Line | 493 BLACKWELL RD 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 | DR. JYOTHI GADDE
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Credential | M.D.
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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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