Provider Demographics
NPI:1770501652
Name:GADDE, JYOTHI (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:
Last Name:GADDE
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 BLACKWELL RD
Mailing Address - Street 2:305
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2639
Mailing Address - Country:US
Mailing Address - Phone:540-428-1715
Mailing Address - Fax:540-428-1716
Practice Address - Street 1:493 BLACKWELL RD
Practice Address - Street 2:305
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2639
Practice Address - Country:US
Practice Address - Phone:540-428-1715
Practice Address - Fax:540-428-1716
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056351207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007603436Medicaid
VAC62079Medicare UPIN
VA007603436Medicaid
DC156315Medicare PIN
VA00W216J01Medicare PIN