MEDICARE: DR. GOPAL CHALAVARYA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME53574	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	185990	OTHER	FL	WELLCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00902	OTHER	FL	UNIVERSAL
4	14899	OTHER	FL	BCBS
5	204168	OTHER		AVMED
6	060063820	OTHER		RRW MCR
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922093921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GOPAL CHALAVARYA MD

Provider Business Mailing Address
First Line	:	PO BOX 7386
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34674-7386
Country	:	US
Telephone Number	:	727-862-8383
Fax Number	:	727-863-4766

Provider Business Practice Location Address
First Line	:	7614 JACQUE RD
Second Line	:	STE C
City	:	HUDSON
State	:	FL
Zip	:	34667-7195
Country	:	US
Telephone Number	:	727-862-8383
Fax Number	:	727-863-4766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	03/09/2010

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Directions to “ DR. GOPAL CHALAVARYA MD” Practice Location

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