Healthcare Provider Details

I. General information

NPI: 1962665877
Provider Name (Legal Business Name): RAHUL R CHOPRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 S PINE ST
MELBOURNE FL
32901-3119
US

IV. Provider business mailing address

PO BOX 534595
ATLANTA GA
30353-4595
US

V. Phone/Fax

Practice location:
  • Phone: 321-952-0898
  • Fax: 321-722-1342
Mailing address:
  • Phone: 321-952-0898
  • Fax: 321-722-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME105638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: