Provider Demographics
NPI:1043280787
Name:GOPALAN, RADHA S (MD)
Entity type:Individual
Prefix:DR
First Name:RADHA
Middle Name:S
Last Name:GOPALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SELVARATNAM
Other - Middle Name:
Other - Last Name:RADHAGOPALAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1111 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2612
Mailing Address - Country:US
Mailing Address - Phone:602-839-9300
Mailing Address - Fax:602-839-2720
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-839-9300
Practice Address - Fax:602-839-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37954207RC0000X, 207RA0001X
NY271514207RC0000X
PAMD065957L207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
AZP00473343OtherRAILROAD MEDICARE
AZ86080015085054D001OtherTRICARE
PA001855929Medicaid
AZ307101Medicaid
PA232359401OtherMAIN LINE HEALTHCARE
AZ307101Medicaid
PA049682HK1Medicare ID - Type Unspecified