Provider Demographics
NPI:1649568288
Name:MAHARAJA, GOPI KIRAN (MD)
Entity type:Individual
Prefix:DR
First Name:GOPI
Middle Name:KIRAN
Last Name:MAHARAJA
Suffix:
Gender:U
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:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:106 PARK PLACE BLVD STE C
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6868
Practice Address - Country:US
Practice Address - Phone:863-588-4775
Practice Address - Fax:863-422-7664
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12604412208D00000X, 208D00000X
FLME126044282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No282N00000XHospitalsGeneral Acute Care Hospital