Basic Information
| Provider Information | |||||||||
| NPI: | 1144604505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GADDAM | ||||||||
| FirstName: | MANEESH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MEDICAL DR | ||||||||
| Address2: | ARH MEDICAL AND SPECIALTY ASSOCIATES-HAZARD | ||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064877510 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | HAZARD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 417019466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064877510 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 56341 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.