Provider Demographics
NPI:1164478111
Name:KALAMANGALAM, GIRIDHAR P (MD)
Entity Type:Individual
Prefix:
First Name:GIRIDHAR
Middle Name:P
Last Name:KALAMANGALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100236
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0236
Mailing Address - Country:US
Mailing Address - Phone:352-273-5550
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0236
Practice Address - Country:US
Practice Address - Phone:352-273-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFTL 412662084N0400X
TXFTL 421762084N0400X
TXFTL 425882084N0400X
FLMFC17892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R6146OtherBCBS
FLJB421ZOtherMEDICARE
FL021663900Medicaid
TX181044201Medicaid
TXP00363979Medicare PIN
TX8R6146OtherBCBS
TX181044201Medicaid