Provider Demographics
NPI:1699858316
Name:GOLLAPUDY, RADHIKA (MD)
Entity Type:Individual
Prefix:MRS
First Name:RADHIKA
Middle Name:
Last Name:GOLLAPUDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 OXFORD DRIVE
Mailing Address - Street 2:UPPER ARLINLOA
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220
Mailing Address - Country:US
Mailing Address - Phone:614-326-1410
Mailing Address - Fax:
Practice Address - Street 1:1301 NORTH HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201
Practice Address - Country:US
Practice Address - Phone:614-299-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074990207Q00000X, 207QA0401X
OH3507499042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2100969Medicaid
OH2100969Medicaid
OHG00863181Medicare ID - Type Unspecified