Provider Demographics
NPI:1821057365
Name:GADI, BHASKARA VVB (MD)
Entity Type:Individual
Prefix:
First Name:BHASKARA
Middle Name:VVB
Last Name:GADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAGHAVARAO
Other - Middle Name:V
Other - Last Name:GADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1350 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4124
Mailing Address - Country:US
Mailing Address - Phone:636-931-3655
Mailing Address - Fax:636-933-0293
Practice Address - Street 1:1350 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-931-3655
Practice Address - Fax:636-933-0293
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013015144207RH0003X
NC2007-00397207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7984868OtherAETNA
KSP01321591OtherRR MEDICARE
810504OtherPARTNERS
VA1821057365Medicaid
MO200589660BMedicaid
MOP01230378OtherRR MEDICARE
SCQ00039HMedicaid
AR158716001Medicaid
KS200589660CMedicaid
145HUOtherBCBS
MO1821057365Medicaid
199168OtherMEDCOST
NC5906822Medicaid
WV3810009175Medicaid
KS200589660CMedicaid
KS110621026Medicare PIN
810504OtherPARTNERS
MO1821057365Medicaid
NC5906822Medicaid
VA1821057365Medicaid