MEDICARE: GAUTHAM GONDI MD

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	207X00000X	Orthopaedic Surgery Physician	0101055531	VA
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	90617	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00220180	OTHER	VA	MEDICARE RAILROAD PIN

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	:	1952336034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAUTHAM GONDI MD

Provider Business Mailing Address
First Line	:	2405 ATHERHOLT RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-2184
Country	:	US
Telephone Number	:	434-485-8500
Fax Number	:	434-485-8599

Provider Business Practice Location Address
First Line	:	146 E HOSPITAL DR STE 350
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-4800
Country	:	US
Telephone Number	:	803-314-9640
Fax Number	:	803-314-9641

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/18/2026

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Directions to “ GAUTHAM GONDI MD” Practice Location

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