Provider Demographics
NPI:1558859165
Name:GADDAM, ANURAG
Entity type:Individual
Prefix:MR
First Name:ANURAG
Middle Name:
Last Name:GADDAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRG MIDCITY MEDICINE CLINIC
Mailing Address - Street 2:3401 N. BLVD , SUITE 130
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-387-7900
Mailing Address - Fax:
Practice Address - Street 1:BRG MIDCITY MEDICINE CLINIC
Practice Address - Street 2:3401 N. BLVD , SUITE 130
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-387-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-12-10
Deactivation Date:2018-12-05
Deactivation Code:
Reactivation Date:2018-12-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program