Provider Demographics
NPI:1770883522
Name:GOMADAM, SARITHA R (DO)
Entity type:Individual
Prefix:DR
First Name:SARITHA
Middle Name:R
Last Name:GOMADAM
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:740 S LIMESTONE ST
Mailing Address - Street 2:K512
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-8178
Mailing Address - Fax:859-323-8926
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-8178
Practice Address - Fax:859-323-8926
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT012529207R00000X
MDH71870207R00000X
KY03817207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD046498800Medicaid
MD222584Y82Medicare PIN