Provider Demographics
NPI:1912342478
Name:GOLLAMUDI, JAHNAVI (MD)
Entity type:Individual
Prefix:DR
First Name:JAHNAVI
Middle Name:
Last Name:GOLLAMUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAHNAVI
Other - Middle Name:
Other - Last Name:VADAPARTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-3887
Mailing Address - Fax:
Practice Address - Street 1:3130 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2399
Practice Address - Country:US
Practice Address - Phone:513-475-8500
Practice Address - Fax:513-584-4281
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.137401207RH0003X, 207RH0000X
TXS5172207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0008976Medicaid
KY7100838280Medicaid