Provider Demographics
NPI:1922093921
Name:CHALAVARYA, GOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:
Last Name:CHALAVARYA
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:PO BOX 7386
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-7386
Mailing Address - Country:US
Mailing Address - Phone:727-862-8383
Mailing Address - Fax:727-863-4766
Practice Address - Street 1:7614 JACQUE RD
Practice Address - Street 2:STE C
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7195
Practice Address - Country:US
Practice Address - Phone:727-862-8383
Practice Address - Fax:727-863-4766
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53574207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL185990OtherWELLCARE
FL371068800Medicaid
FL00902OtherUNIVERSAL
FL14899OtherBCBS
204168OtherAVMED
060063820OtherRRW MCR
FL185990OtherWELLCARE
204168OtherAVMED