Provider Demographics
NPI:1558437897
Name:GOPALASWAMY, CHITRA (MD)
Entity Type:Individual
Prefix:
First Name:CHITRA
Middle Name:
Last Name:GOPALASWAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHITRA
Other - Middle Name:
Other - Last Name:GOPA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4740 S OCEAN BLVD APT 1108
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5358
Mailing Address - Country:US
Mailing Address - Phone:917-670-5121
Mailing Address - Fax:
Practice Address - Street 1:76 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6719
Practice Address - Country:US
Practice Address - Phone:718-395-6444
Practice Address - Fax:212-300-5472
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132241207R00000X, 207RG0300X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00552570Medicaid
B14377Medicare UPIN
42A841Medicare ID - Type Unspecified