Provider Demographics
NPI:1508833211
Name:ADHINARAYANAN, BALLAPURAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:BALLAPURAM
Middle Name:G
Last Name:ADHINARAYANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:B
Other - Middle Name:
Other - Last Name:ADHINARAYANAN MD PA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2400 HARBOR BLVD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-613-1223
Mailing Address - Fax:941-613-1224
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-613-1223
Practice Address - Fax:941-613-1224
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36447207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039715600Medicaid
FL100013032OtherRAILROAD MEDICARE
FL100013032OtherRAILROAD MEDICARE
FL08098Medicare ID - Type Unspecified