Provider Demographics
NPI:1548433816
Name:GADKOWSKI, LARA BETH (MD MPH MS)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:BETH
Last Name:GADKOWSKI
Suffix:
Gender:F
Credentials:MD MPH MS
Other - Prefix:
Other - First Name:L
Other - Middle Name:BETH
Other - Last Name:GADKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:DC-15 C
Mailing Address - Street 2:1600 SW ARCHER ROAD
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601
Mailing Address - Country:US
Mailing Address - Phone:352-294-5481
Mailing Address - Fax:352-392-6481
Practice Address - Street 1:1600 SW ARCHER RD BOX 100277
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1914
Practice Address - Country:US
Practice Address - Phone:352-273-9804
Practice Address - Fax:352-392-6481
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243280207RI0200X
FLME132097207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021801000Medicaid
VAPAROtherCORVEL/CORCARE
VA-032OtherTRICARE
VA10033740OtherSENTARA/OPTIMA
VA1548433816Medicaid
VAP00701483Medicare PIN
VA1100454OtherUSA MANAGED CARE
NC5909655Medicaid
VAPAROtherMULTIPLAN
VA355493OtherANTHEM
VA9753154OtherAETNA
VAPAROtherVA HEALTH NETWORK
NC09655OtherBC/BS
VA2180671OtherUHC/MAMSI
VIPAROtherVA PREMIER HEALTH
VA7843189OtherCIGNA
VA017800E30Medicare PIN