Provider Demographics
NPI:1124016902
Name:NARAYANA, GONCHIGARI (MD)
Entity Type:Individual
Prefix:DR
First Name:GONCHIGARI
Middle Name:
Last Name:NARAYANA
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 1:4350 7TH STREET A
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:566-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:4350 7TH STREET A
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:566-355-9191
Practice Address - Fax:563-355-3419
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA307802084P0800X
IL0360793042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42884OtherWELLMARK HEALTH PLAN
IA3136002Medicaid
IA01B1OtherJOHN DEERE HEALTH PLAN
IAI17979Medicare PIN
E60083Medicare UPIN
IA01B1OtherJOHN DEERE HEALTH PLAN