Provider Demographics
NPI:1053316042
Name:KAMATH, GIRIDHAR CHOLPADY (DO)
Entity Type:Individual
Prefix:DR
First Name:GIRIDHAR
Middle Name:CHOLPADY
Last Name:KAMATH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 TROY SCHENECTADY ROAD
Mailing Address - Street 2:SUITE LL01
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-867-8080
Mailing Address - Fax:518-867-8088
Practice Address - Street 1:1182 TROY SCHENECTADY ROAD
Practice Address - Street 2:SUITE LL01
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-867-8080
Practice Address - Fax:518-867-8088
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011858207Q00000X
NY230087207Q00000X
ME1884207Q00000X
GA056306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02510516Medicaid
NY069791Medicare ID - Type Unspecified
NYH84154Medicare UPIN