Provider Demographics
NPI:1215975321
Name:GOPALAN, NANDA K (MD)
Entity type:Individual
Prefix:DR
First Name:NANDA
Middle Name:K
Last Name:GOPALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KUGATHASAN
Other - Middle Name:
Other - Last Name:NANHAGOPALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:7848 GATEWAY BLVD E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1815
Practice Address - Country:US
Practice Address - Phone:915-599-1313
Practice Address - Fax:915-599-1701
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2416207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176321102Medicaid
NM06556213Medicaid
TX176321103Medicaid
TX176321101Medicaid
TX8S7057OtherBLUE CROSS OF TX
TX8G3199Medicare PIN
TX176321101Medicaid
TXH53325Medicare PIN
H53325Medicare UPIN
TX8G0188Medicare PIN
TX176321102Medicaid