Provider Demographics
NPI:1669472601
Name:NANDYAL, RAJAGOPAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAGOPAL
Middle Name:R
Last Name:NANDYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJA
Other - Middle Name:R
Other - Last Name:NANDYAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2617 LILLEHAMMER DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9157
Mailing Address - Country:US
Mailing Address - Phone:405-285-2820
Mailing Address - Fax:405-271-1236
Practice Address - Street 1:O.U. MEDICAL CENTER, 1200 EVERETT DR,
Practice Address - Street 2:7TH FLOOR, NORTH PAVILION
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-5215
Practice Address - Fax:405-271-1236
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK115992080N0001X
WI242282080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11599OtherMEDICAL LICENSE
WI24228OtherMEDICAL LICENSE
OK11599OtherMEDICAL LICENSE