Provider Demographics
NPI:1437380805
Name:GUNDU, GIRIDHAR (MD)
Entity Type:Individual
Prefix:
First Name:GIRIDHAR
Middle Name:
Last Name:GUNDU
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 1:8 ROLLESTON DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6736
Mailing Address - Country:US
Mailing Address - Phone:864-283-2245
Mailing Address - Fax:
Practice Address - Street 1:22971 HIGHWAY 76 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7529
Practice Address - Country:US
Practice Address - Phone:864-833-3046
Practice Address - Fax:864-833-3046
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2837208100000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program