Provider Demographics
NPI:1447257795
Name:GUMMADI, P. RAO (MD)
Entity type:Individual
Prefix:DR
First Name:P.
Middle Name:RAO
Last Name:GUMMADI
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 1:1818 CAREW ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4788
Mailing Address - Country:US
Mailing Address - Phone:260-482-1004
Mailing Address - Fax:260-483-7894
Practice Address - Street 1:1818 CAREW ST
Practice Address - Street 2:SUITE 220
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4788
Practice Address - Country:US
Practice Address - Phone:260-482-1004
Practice Address - Fax:260-483-7894
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030939A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000082077OtherANTHEM BC/BS
IN1360OtherPHP
IN000000082077OtherANTHEM BC/BS
E46558Medicare UPIN