Provider Demographics
NPI:1336199215
Name:CHOPRA, RAMESH K (MD)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:K
Last Name:CHOPRA
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 1:545 HEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1493
Mailing Address - Country:US
Mailing Address - Phone:386-239-8500
Mailing Address - Fax:
Practice Address - Street 1:633 DUNLAWTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4342
Practice Address - Country:US
Practice Address - Phone:386-756-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034323208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1900414OtherUNITED HEALTHCARE
FL063291100Medicaid
10274OtherBLUE SHIELD
340014853OtherRR MEDICARE
D65448Medicare UPIN
10274OtherBLUE SHIELD