Provider Demographics
NPI:1922319565
Name:ABHINAND V PEDDADA MD
Entity Type:Organization
Organization Name:ABHINAND V PEDDADA MD
Other - Org Name:LOS GATOS RADIATION ONCOLOGY ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABHINAND
Authorized Official - Middle Name:V
Authorized Official - Last Name:PEDDADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-342-2300
Mailing Address - Street 1:4301 N STAR WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9262
Mailing Address - Country:US
Mailing Address - Phone:209-342-2300
Mailing Address - Fax:209-524-4240
Practice Address - Street 1:15400 NATIONAL AVE
Practice Address - Street 2:100
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2433
Practice Address - Country:US
Practice Address - Phone:408-358-8400
Practice Address - Fax:209-524-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA478182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty