Provider Demographics
NPI:1174649362
Name:JYOTHI GADDE M.D., P.A.
Entity Type:Organization
Organization Name:JYOTHI GADDE M.D., P.A.
Other - Org Name:ALLERGY AND ASTHMA SPECIALISTS OF GREATER WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-428-1715
Mailing Address - Street 1:493 BLACKWELL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2628
Mailing Address - Country:US
Mailing Address - Phone:540-428-1715
Mailing Address - Fax:540-428-1716
Practice Address - Street 1:493 BLACKWELL RD STE 305
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2628
Practice Address - Country:US
Practice Address - Phone:540-428-1715
Practice Address - Fax:540-428-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7603436Medicaid
VA7603436Medicaid
VAC09350Medicare Oscar/Certification
VA491846Medicare PIN