Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 37954 | AZ |
N | 207RC0000X | Internist - Cardiovascular Disease | 271514 | NY |
N | 207RC0000X | Internist - Cardiovascular Disease | 37954 | AZ |
N | 207RC0000X | Internist - Cardiovascular Disease | MD065957L | PA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | MD065957L | PA |
NPI | 1043280787 |
---|---|
Provider Name | Dr. Radha S Gopalan |
First Address | New York, NY 10029-6504 |
Second Address | New York, NY 10029-6501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 29/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001855929 | (05) | PA |
232359401 | MAIN LINE HEALTHCARE (01) | PA |
307101 | (05) | AZ |
86080015085054D001 | TRICARE (01) | AZ |
H45547 | (02) | |
P00473343 | RAILROAD MEDICARE (01) | AZ |