Provider Demographics
NPI:1306179486
Name:GOPAL, ABILASH (MD)
Entity Type:Individual
Prefix:
First Name:ABILASH
Middle Name:
Last Name:GOPAL
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 1:2161 UNION ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-4003
Mailing Address - Country:US
Mailing Address - Phone:415-494-9329
Mailing Address - Fax:
Practice Address - Street 1:2161 UNION ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4003
Practice Address - Country:US
Practice Address - Phone:415-494-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 1093172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry