Provider Demographics
NPI:1740568278
Name:MADHANAGOPAL, HARRY (DO)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:MADHANAGOPAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-296-5691
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:9130 RG SKINNER
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:049-538-0950
Practice Address - Fax:904-538-0952
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02004163A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine