Provider Demographics
NPI:1043339005
Name:GADDY, JOSEPH NELSON (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NELSON
Last Name:GADDY
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 1:3329 NOTTINGHILL DR E
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-8308
Mailing Address - Country:US
Mailing Address - Phone:317-839-9359
Mailing Address - Fax:
Practice Address - Street 1:2525 N SHADELAND AVE
Practice Address - Street 2:SUITE105
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1787
Practice Address - Country:US
Practice Address - Phone:317-396-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030790A207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB52949Medicare UPIN