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General NPI Number Information
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NPI Number | 1952336034
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Entity Type | Individual
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Provider Name | GAUTHAM GONDI MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 146 E HOSPITAL DR STE 350
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4800
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Country | US
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Telephone | 803-314-9640
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Fax | 803-314-9641
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Provider Business Mailing Address
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Address Line | 2405 ATHERHOLT RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-2184
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Country | US
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Telephone | 434-485-8500
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Fax | 434-485-8599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101055531
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 90617
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License Number State | SC
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