Provider Demographics
NPI:1356347876
Name:GOUD, GUNDUMALLA S (MD)
Entity type:Individual
Prefix:
First Name:GUNDUMALLA
Middle Name:S
Last Name:GOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FL
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-692-1144
Mailing Address - Fax:216-201-4536
Practice Address - Street 1:7500 AUBURN RD # 2300
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9176
Practice Address - Country:US
Practice Address - Phone:440-350-7444
Practice Address - Fax:440-350-7440
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0468480Medicaid
OH0468480Medicaid
OHD31248Medicare UPIN