Provider Demographics
NPI:1023012804
Name:GOPAL, PUSHPA (MD)
Entity Type:Individual
Prefix:
First Name:PUSHPA
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 1:238 SUTTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1631
Mailing Address - Country:US
Mailing Address - Phone:978-327-5039
Mailing Address - Fax:
Practice Address - Street 1:238 SUTTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1631
Practice Address - Country:US
Practice Address - Phone:978-327-5039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27586OtherBLUE CROSS BLUE SHIELD
MA466502OtherTUFTS HEALTH PLAN
MA2095611Medicaid
MAAA53435OtherHARVARD PILGRIM
MA2095611Medicaid
MAA32678Medicare ID - Type Unspecified