Provider Demographics
NPI:1053316042
Name:KAMATH, GIRIDHAR CHOLPADY (DO)
Entity type:Individual
Prefix:DR
First Name:GIRIDHAR
Middle Name:CHOLPADY
Last Name:KAMATH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EVERETT RD EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3357
Mailing Address - Country:US
Mailing Address - Phone:518-867-8080
Mailing Address - Fax:
Practice Address - Street 1:21 EVERETT RD EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3357
Practice Address - Country:US
Practice Address - Phone:518-867-8080
Practice Address - Fax:518-867-8088
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2300872083X0100X
PAOS011858207Q00000X
ME1884207Q00000X
GA056306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02510516Medicaid
NY069791Medicare ID - Type Unspecified
NYH84154Medicare UPIN