| Gopal Tatambhotla Md Pa | |
|
534 N Lecanto Hwy Lecanto FL 34461-8547 | |
| (352) 527-9500 | |
| (352) 527-7215 |
| Full Name | Gopal Tatambhotla Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 534 N Lecanto Hwy, Lecanto, Florida |
| Authorized Official Name and Position | Gopal Tatambhotla (OWNER) |
| Authorized Official Contact | 3525279500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gopal Tatambhotla Md Pa Po Box 700 Lecanto FL 34460-0700 Ph: (352) 527-9500 | Gopal Tatambhotla Md Pa 534 N Lecanto Hwy Lecanto FL 34461-8547 Ph: (352) 527-9500 |
| NPI Number | 1679887988 |
|---|---|
| Provider Enumeration Date | 07/28/2010 |
| Last Update Date | 07/28/2010 |
| Medicare PECOS PAC ID | 8123285442 |
|---|---|
| Medicare Enrollment ID | O20120130000019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679887988 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | ME72857 (Florida) | Primary |
| Provider Name | Gopal Tatambhotla |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1881750073 PECOS PAC ID: 7214194539 Enrollment ID: I20120130000017 |
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