Provider Demographics
NPI:1699728055
Name:GADDIPATI, JAGADEESH C (MD)
Entity type:Individual
Prefix:
First Name:JAGADEESH
Middle Name:C
Last Name:GADDIPATI
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 1:1401 CHESTER BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1908
Mailing Address - Country:US
Mailing Address - Phone:765-983-3245
Mailing Address - Fax:765-983-3247
Practice Address - Street 1:1401 CHESTER BLVD
Practice Address - Street 2:STE C
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1908
Practice Address - Country:US
Practice Address - Phone:765-983-3245
Practice Address - Fax:765-983-3247
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039041A207RH0003X
OH35-06-1836G207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH845143Medicaid
OH845143Medicaid
IN904680BMedicare ID - Type Unspecified
E74071Medicare UPIN