Provider Demographics
NPI:1740235662
Name:GUMMADI, SARADA (MD)
Entity type:Individual
Prefix:
First Name:SARADA
Middle Name:
Last Name:GUMMADI
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2250
Mailing Address - Fax:956-362-2251
Practice Address - Street 1:2717 MICHAELANGELO DR STE 200
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1412
Practice Address - Country:US
Practice Address - Phone:956-362-2250
Practice Address - Fax:956-362-2251
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2965207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181141603Medicaid
TX181141602Medicaid
TX181141601Medicaid
TX181141603Medicaid
TX8J1444Medicare PIN
TX8G5822Medicare PIN