Provider Demographics
NPI:1427278696
Name:GADDE, SUMANA (MD)
Entity type:Individual
Prefix:DR
First Name:SUMANA
Middle Name:
Last Name:GADDE
Suffix:
Gender:F
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1246
Mailing Address - Fax:704-384-6072
Practice Address - Street 1:845 CHURCH ST N STE 203
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4374
Practice Address - Country:US
Practice Address - Phone:704-316-5027
Practice Address - Fax:704-316-5028
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV246982084P0804X
NC2017-008192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022762Medicaid
WVWV1806AMedicare UPIN