Provider Demographics
NPI:1013917541
Name:VENUGOPAL, CHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:
Last Name:VENUGOPAL
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 1:3347 STATE ROAD
Mailing Address - Street 2:STE 203
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8095
Mailing Address - Country:US
Mailing Address - Phone:561-793-6100
Mailing Address - Fax:561-793-1974
Practice Address - Street 1:3347 STATE ROAD 7
Practice Address - Street 2:SUITE 203
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8095
Practice Address - Country:US
Practice Address - Phone:561-793-6100
Practice Address - Fax:561-793-1974
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038526207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066569000Medicaid
FL61206AMedicare ID - Type Unspecified
FLD65252Medicare UPIN