Provider Demographics
NPI:1467767343
Name:C. RAMGOPAL M.D. P.C.
Entity Type:Organization
Organization Name:C. RAMGOPAL M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINNIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMGOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-897-1340
Mailing Address - Street 1:2343 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-2312
Mailing Address - Country:US
Mailing Address - Phone:716-897-1340
Mailing Address - Fax:716-897-1581
Practice Address - Street 1:2343 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-2312
Practice Address - Country:US
Practice Address - Phone:716-897-1340
Practice Address - Fax:716-897-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY052791Medicare PIN
B71451Medicare UPIN
NY00650019Medicare PIN