Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME0038526 | FL |
NPI | 1013917541 |
---|---|
Provider Name | Dr. Chandra Venugopal |
First Address | Wellington, FL 33449-8095 |
Second Address | Wellington, FL 33449-8095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 16/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
066569000 | (05) | FL |
D65252 | (02) | FL |