Provider Demographics
NPI:1831167899
Name:GADE, GOPAL REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:GOPAL REDDY
Middle Name:
Last Name:GADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6183 N FRESNO ST
Mailing Address - Street 2:STE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5207
Mailing Address - Country:US
Mailing Address - Phone:559-261-0794
Mailing Address - Fax:559-261-0797
Practice Address - Street 1:6183 N FRESNO ST
Practice Address - Street 2:STE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5207
Practice Address - Country:US
Practice Address - Phone:559-261-0794
Practice Address - Fax:559-261-0797
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-10-22
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAA35041207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A350410Medicaid
CAA88319Medicare UPIN
CA00A350410Medicare ID - Type UnspecifiedPROVIDER NUMBER