Provider Demographics
NPI:1437464336
Name:MEDAM, GURU PADMAKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:GURU
Middle Name:PADMAKAR
Last Name:MEDAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:264 NEW SHACKLE ISLAND RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2481
Mailing Address - Country:US
Mailing Address - Phone:615-824-4244
Mailing Address - Fax:615-824-5916
Practice Address - Street 1:264 NEW SHACKLE ISLAND RD STE 107
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2481
Practice Address - Country:US
Practice Address - Phone:615-824-4244
Practice Address - Fax:615-824-5916
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2013-0703207Q00000X, 207Q00000X
TN55403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine