Provider Demographics
NPI:1811909161
Name:GOVINDARAJAN, BALACHANDER (MD)
Entity type:Individual
Prefix:
First Name:BALACHANDER
Middle Name:
Last Name:GOVINDARAJAN
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 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-726-5038
Practice Address - Street 1:910 OLD CAMP RD STE 210
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5605
Practice Address - Country:US
Practice Address - Phone:352-751-3356
Practice Address - Fax:352-751-3359
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102278207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53211OtherBCBS OF FL
FL269859500OtherMEDICAID GROUP
FL77940OtherMEDICARE GROUP ID
FLME102278OtherSTATE MEDICAL LICENSE
FLP00684339OtherMEDICARE RR
FLCF1416OtherMEDICARE RR GROUP
FL000420000Medicaid
FL11869687OtherCAQH
FL2097661OtherCIGNA
FL77940OtherBCBS OF FL GROUP ID
FL269859500OtherMEDICAID GROUP