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1245287713

NPI Code Detail

MEDICARE: RADHARANI S. GOLLAMUDI M.D.

MEDICARE: RADHARANI S. GOLLAMUDI M.D.

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	207R00000X	Internal Medicine Physician	01072789A	IN
2	207R00000X	Internal Medicine Physician	ME109538	FL
3	207R00000X	Internal Medicine Physician	238672	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FB967Y	OTHER	FL	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1245287713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADHARANI S. GOLLAMUDI M.D.

Provider Business Mailing Address
First Line	:	1630 MASON AVE STE C
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4503
Country	:	US
Telephone Number	:	386-238-9064
Fax Number	:	386-238-9064

Provider Business Practice Location Address
First Line	:	1630 MASON AVE STE C
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4503
Country	:	US
Telephone Number	:	386-238-9064
Fax Number	:	386-238-9064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	04/07/2026

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Directions to “ RADHARANI S. GOLLAMUDI M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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