Provider Demographics
NPI:1295893501
Name:GADDIPATI, ANITHA (MD)
Entity type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:GADDIPATI
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 1:751 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:408-885-5000
Mailing Address - Fax:
Practice Address - Street 1:150 W HEDDING ST
Practice Address - Street 2:MAIN JAIL MEDICAL UNIT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1706
Practice Address - Country:US
Practice Address - Phone:408-808-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH48104Medicare UPIN
CA00A748792Medicare PIN