Provider Demographics
NPI:1124017645
Name:TRIVEDI, GOPALKRISHA M (MD)
Entity Type:Individual
Prefix:
First Name:GOPALKRISHA
Middle Name:M
Last Name:TRIVEDI
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:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0750
Mailing Address - Country:US
Mailing Address - Phone:570-346-7797
Mailing Address - Fax:570-342-9802
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:LEWISTOWN HOSPITAL
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1167
Practice Address - Country:US
Practice Address - Phone:717-242-7208
Practice Address - Fax:717-242-7540
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 023488 E207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009395050004Medicaid
PA0009395050004Medicaid
PA159978Medicare ID - Type Unspecified
D32310Medicare UPIN