Provider Demographics
NPI:1073518494
Name:GADIPUDI, VENUGOPAL NAIDU (MD)
Entity Type:Individual
Prefix:
First Name:VENUGOPAL
Middle Name:NAIDU
Last Name:GADIPUDI
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:PO BOX 1689
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729-1689
Mailing Address - Country:US
Mailing Address - Phone:828-891-5524
Mailing Address - Fax:828-891-4069
Practice Address - Street 1:2500 VILLAGE DR
Practice Address - Street 2:STE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3811
Practice Address - Country:US
Practice Address - Phone:910-484-0029
Practice Address - Fax:910-484-0275
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004008632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561775962OtherCOMMERICAL
NC891375AMedicaid
NC13754AOtherBCBS
NC561775962OtherTRICARE
NC2033295Medicare ID - Type Unspecified
NC561775962OtherTRICARE