Provider Demographics
NPI:1194872713
Name:GUDLA, JYOTHI DYAVANAPALLI (MD)
Entity type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:DYAVANAPALLI
Last Name:GUDLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JYOTHI
Other - Middle Name:D
Other - Last Name:GUDLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4808 MUNSON ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3613
Mailing Address - Country:US
Mailing Address - Phone:330-460-4115
Mailing Address - Fax:330-832-3499
Practice Address - Street 1:4808 MUNSON ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3613
Practice Address - Country:US
Practice Address - Phone:330-622-0207
Practice Address - Fax:330-832-3499
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083145208M00000X, 207R00000X
OH35.083145207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine