Basic Information
| Provider Information | |||||||||
| NPI: | 1083935100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POOVENDRAN | ||||||||
| FirstName: | GAYAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 162743 | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327162743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545804084 | ||||||||
| FaxNumber: | 9545305096 | ||||||||
| Practice Location | |||||||||
| Address1: | 2825 N STATE ROAD 7 STE 204 | ||||||||
| Address2: | |||||||||
| City: | MARGATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330635737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545804080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2010 | ||||||||
| LastUpdateDate: | 02/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | ME121381 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.