Provider Demographics
NPI:1558711606
Name:GUMMADI, NAVEEN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NAVEEN
Middle Name:KUMAR
Last Name:GUMMADI
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 1:500 GYPSY LANE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501
Mailing Address - Country:US
Mailing Address - Phone:330-884-4250
Mailing Address - Fax:330-884-0651
Practice Address - Street 1:500 GYPSY LANE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44501
Practice Address - Country:US
Practice Address - Phone:330-884-4250
Practice Address - Fax:330-884-0651
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2019-07-02
Deactivation Date:2017-02-02
Deactivation Code:
Reactivation Date:2017-03-15
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine