Provider Demographics
NPI:1023379229
Name:GOPI MUKKAVILLI, MD
Entity Type:Organization
Organization Name:GOPI MUKKAVILLI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAOMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-482-3701
Mailing Address - Street 1:4065 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-5243
Mailing Address - Country:US
Mailing Address - Phone:609-482-3701
Mailing Address - Fax:609-482-3702
Practice Address - Street 1:4065 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-5243
Practice Address - Country:US
Practice Address - Phone:609-482-3701
Practice Address - Fax:609-482-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty