Provider Demographics
NPI:1952336034
Name:GONDI, GAUTHAM (MD)
Entity type:Individual
Prefix:
First Name:GAUTHAM
Middle Name:
Last Name:GONDI
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 1:2405 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2184
Mailing Address - Country:US
Mailing Address - Phone:434-485-8500
Mailing Address - Fax:434-485-8599
Practice Address - Street 1:146 E HOSPITAL DR STE 141
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-314-9640
Practice Address - Fax:803-314-9641
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055531207X00000X
SC90617207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010160910Medicaid
VA1952336034Medicaid
VAP00220180OtherMEDICARE RAILROAD PIN
00W355O15Medicare PIN
G51723Medicare UPIN
VA1952336034Medicaid
VVJ626AMedicare PIN