Individual
DR. NANDAGOPAL S VRINDAVANAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6555 CORTEZ RD W, BRADENTON, FL 34210-2608
(727) 344-6569
(727) 384-4388
Mailing address
5000 PARK ST N STE 1017, ST PETERSBURG, FL 33709-2236
(727) 344-6570
(727) 384-4388
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
ME126543
FL
207RH0003X
Hematology & Oncology Physician
Q8181
TX
207RX0202X
Medical Oncology Physician
Primary
ME126543
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103361400
—
FL
05
—
3590879-01
—
TX
01
—
7FNM3
BCBS FL
FL
01
—
LI139
MEDICARE
FL
01
—
LI140
MEDICARE
FL
Enumeration date
10/04/2005
Last updated
01/24/2020
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