Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35074990 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35074990 | OH |
NPI | 1699858316 |
---|---|
Provider Name | Mrs. Radhika Gollapudy |
First Address | Columbus, OH 43220 |
Second Address | Columbus, OH 43201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 17/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2100969 | (05) | OH |
G83074 | (02) |