Provider Demographics
NPI:1235266867
Name:GOPAL, RICHA (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHA
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 1:17 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1757
Mailing Address - Country:US
Mailing Address - Phone:609-395-2939
Mailing Address - Fax:609-395-4179
Practice Address - Street 1:312 APPLEGARTH RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-5347
Practice Address - Country:US
Practice Address - Phone:609-395-2939
Practice Address - Fax:609-395-4179
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08380400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0138673Medicaid
146841ZEL1Medicare PIN