Provider Demographics
NPI:1235407602
Name:NEDU GOPALA, M.D., P.C.
Entity Type:Organization
Organization Name:NEDU GOPALA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDU
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-460-0109
Mailing Address - Street 1:3250 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-1444
Mailing Address - Country:US
Mailing Address - Phone:812-460-0109
Mailing Address - Fax:
Practice Address - Street 1:3250 N 19TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-1444
Practice Address - Country:US
Practice Address - Phone:812-460-0109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040752A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100384930Medicaid
IN194960Medicare PIN
IN100384930Medicaid