Provider Demographics
NPI:1306842984
Name:GADODIA, GOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:
Last Name:GADODIA
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 1:2200 W EAU GALLIE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3166
Mailing Address - Country:US
Mailing Address - Phone:321-255-1500
Mailing Address - Fax:321-254-0400
Practice Address - Street 1:2200 W EAU GALLIE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3166
Practice Address - Country:US
Practice Address - Phone:321-255-1500
Practice Address - Fax:321-254-0400
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57616207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051642200Medicaid
FLA78827Medicare UPIN
FL051642200Medicaid