Provider Demographics
NPI:1073644142
Name:GOPALAN, RAJA S (MD)
Entity Type:Individual
Prefix:
First Name:RAJA
Middle Name:S
Last Name:GOPALAN
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 1:608 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2517
Mailing Address - Country:US
Mailing Address - Phone:716-366-7446
Mailing Address - Fax:716-366-7320
Practice Address - Street 1:608 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2517
Practice Address - Country:US
Practice Address - Phone:716-366-7446
Practice Address - Fax:716-366-7320
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113439208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY31277BMedicare ID - Type UnspecifiedPROVIDER #