Provider Demographics
NPI:1407043748
Name:GAINEDI, PADMA (PA)
Entity Type:Individual
Prefix:
First Name:PADMA
Middle Name:
Last Name:GAINEDI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19801 OBSERVATION DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4070
Mailing Address - Country:US
Mailing Address - Phone:301-754-7991
Mailing Address - Fax:301-754-7990
Practice Address - Street 1:19801 OBSERVATION DR
Practice Address - Street 2:SUITE 202
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4070
Practice Address - Country:US
Practice Address - Phone:301-754-7991
Practice Address - Fax:301-754-7990
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD010632250Medicaid
MD41974000Medicaid