Provider Demographics
NPI:1316967854
Name:GOPURALA, BALAGANESH (MD)
Entity type:Individual
Prefix:
First Name:BALAGANESH
Middle Name:
Last Name:GOPURALA
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 1:11480 BROOKSHIRE AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5025
Mailing Address - Country:US
Mailing Address - Phone:562-869-1201
Mailing Address - Fax:562-869-1281
Practice Address - Street 1:11480 BROOKSHIRE AVE STE 309
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5025
Practice Address - Country:US
Practice Address - Phone:562-869-1201
Practice Address - Fax:562-869-1281
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024965207RH0003X
CAC139871207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936594Medicaid
AL009936597Medicaid
AL51534632OtherBLUE CROSS BLUE SHIELD
AL009936596Medicaid
AL51534631OtherBLUE CROSS BLUE SHIELD
ALH78600OtherHEALTHSPRING OF ALABAMA
AL51003582OtherBLUE CROSS BLUE SHIELD
ALH78600OtherUNITED HEALTHCARE
ALP00314189OtherRAILROAD MEDICARE
AL009936594Medicaid
ALH78600OtherUNITED HEALTHCARE