Provider Demographics
NPI:1609880459
Name:CHAPALAMADUGU, GANGADHARARAO (MD)
Entity type:Individual
Prefix:DR
First Name:GANGADHARARAO
Middle Name:
Last Name:CHAPALAMADUGU
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 1:300 RIVERSIDE DRIVE EAST
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:941-746-1018
Mailing Address - Fax:941-747-3684
Practice Address - Street 1:300 RIVERSIDE DRIVE EAST
Practice Address - Street 2:SUITE 4500
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-746-1018
Practice Address - Fax:941-747-3684
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0030551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D79857Medicare UPIN
FL41151Medicare ID - Type Unspecified