Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 35.094522 | OH |
N | 207RN0300X | Nephrologist | 36942 | KY |
NPI | 1003887381 |
---|---|
Provider Name | Gopi K Gundumalla |
First Address | Chillicothe, OH 45601-8207 |
Second Address | Chillicothe, OH 45601-8207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3011314 | (05) | OH |
3810016457 | (05) | WV |
64053077 | (05) | KY |
H61907 | (02) |