MEDICARE: JYOTHI GADDE M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101056351	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174649362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JYOTHI GADDE M.D., P.A.

Provider Business Mailing Address
First Line	:	493 BLACKWELL RD STE 305
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-2628
Country	:	US
Telephone Number	:	540-428-1715
Fax Number	:	540-428-1716

Provider Business Practice Location Address
First Line	:	493 BLACKWELL RD STE 305
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-2628
Country	:	US
Telephone Number	:	540-428-1715
Fax Number	:	540-428-1716

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JYOTHI GADDE
Credential	:	M.D.
Telephone Number	:	540-428-1715

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/08/2008

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