Provider Demographics
NPI:1114235991
Name:GOPALAN, KANAGALINGAM (MBBS)
Entity Type:Individual
Prefix:DR
First Name:KANAGALINGAM
Middle Name:
Last Name:GOPALAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N ROCKY POINT DR W
Mailing Address - Street 2:SUITE 670
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5906
Mailing Address - Country:US
Mailing Address - Phone:352-671-2254
Mailing Address - Fax:352-671-2291
Practice Address - Street 1:3030 N ROCKY POINT DR W
Practice Address - Street 2:SUITE 670
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5906
Practice Address - Country:US
Practice Address - Phone:352-671-2254
Practice Address - Fax:352-671-2291
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119714207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
443OtherSUFFIX
ATOtherINSTITUTION
FLME119714OtherFLORIDA MEDICAL LICENSE