Provider Demographics
NPI:1003861915
Name:GOPAL, MEENAKSHI (MD)
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:GOPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 AMHERST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3344
Mailing Address - Country:US
Mailing Address - Phone:540-722-0220
Mailing Address - Fax:540-722-0191
Practice Address - Street 1:812 AMHERST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3344
Practice Address - Country:US
Practice Address - Phone:540-722-0220
Practice Address - Fax:540-722-0191
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239078173000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00718282OtherRR MEDICARE
VA016028V83Medicare PIN
VAP00718282OtherRR MEDICARE