Provider Demographics
NPI:1477536035
Name:GAYAM, PADMAJA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMAJA
Middle Name:REDDY
Last Name:GAYAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PADMAJA
Other - Middle Name:REDDY
Other - Last Name:PARVATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:135 PARKWAY OFFICE CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7424
Mailing Address - Country:US
Mailing Address - Phone:919-851-2223
Mailing Address - Fax:919-851-2291
Practice Address - Street 1:135 PARKWAY OFFICE CT
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7424
Practice Address - Country:US
Practice Address - Phone:919-851-2223
Practice Address - Fax:919-851-2291
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701365207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891310PMedicaid
NC891310PMedicaid
NCG82027Medicare UPIN