Provider Demographics
NPI:1902178304
Name:GADE, VAMSHIDHARA R (MD)
Entity Type:Individual
Prefix:
First Name:VAMSHIDHARA
Middle Name:R
Last Name:GADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7215 N FRESNO ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2969
Mailing Address - Country:US
Mailing Address - Phone:559-438-1111
Mailing Address - Fax:559-438-4002
Practice Address - Street 1:7215 N FRESNO ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-438-1111
Practice Address - Fax:559-438-4002
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA122369207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113303OtherSID # 113303