Provider Demographics
NPI:1477800241
Name:GOPAL, ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:GOPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:203-732-1330
Mailing Address - Fax:203-732-1332
Practice Address - Street 1:30 QUAKER FARMS RD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2732
Practice Address - Country:US
Practice Address - Phone:203-262-9300
Practice Address - Fax:855-719-2198
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT034613207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT034613OtherSTATE MEDICAL LICENSE