Provider Demographics
NPI:1639264278
Name:ORANGE COUNTY FIRST MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ORANGE COUNTY FIRST MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:ANAHEIM ORANGE COUNTY FIRST MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SYAM
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:GADDAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-636-9100
Mailing Address - Street 1:1771 W. ROMNEYA DR.
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1817
Mailing Address - Country:US
Mailing Address - Phone:714-520-3000
Mailing Address - Fax:714-520-5742
Practice Address - Street 1:1771 W. ROMNEYA DR.
Practice Address - Street 2:SUITE C
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1817
Practice Address - Country:US
Practice Address - Phone:714-520-3000
Practice Address - Fax:714-520-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095540Medicaid