Provider Demographics
NPI:1124097043
Name:ANDHAVARAPU, GIRIDHAR (MD)
Entity type:Individual
Prefix:
First Name:GIRIDHAR
Middle Name:
Last Name:ANDHAVARAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-2087
Mailing Address - Country:US
Mailing Address - Phone:559-583-4500
Mailing Address - Fax:559-583-4600
Practice Address - Street 1:1524 W LACEY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5965
Practice Address - Country:US
Practice Address - Phone:559-583-4505
Practice Address - Fax:559-583-4545
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10540208000000X
CAA102374208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124097043Medicaid
NV100500087Medicaid
EK765Medicare PIN
NV100500087Medicaid