Provider Demographics
NPI:1043280787
Name:GOPALAN, RADHA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:S
Last Name:GOPALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SELVARATNAM
Other - Middle Name:
Other - Last Name:RADHAGOPALAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 3000
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-987-3100
Mailing Address - Fax:212-731-5210
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-427-1540
Practice Address - Fax:212-410-7196
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271514207RC0000X
PAMD065957L207RC0000X, 207RC0001X
AZ37954207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86080015085054D001OtherTRICARE
AZ307101Medicaid
AZP00473343OtherRAILROAD MEDICARE
PA001855929Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
PA232359401OtherMAIN LINE HEALTHCARE
AZ307101Medicaid
PA049682HK1Medicare ID - Type Unspecified