Provider Demographics
NPI:1508950080
Name:GOPAL, KAPIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KAPIL
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 1:3299 WOODBURN RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1275
Mailing Address - Country:US
Mailing Address - Phone:703-205-7007
Mailing Address - Fax:703-205-7331
Practice Address - Street 1:85 MCNAUGHTEN RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5111
Practice Address - Country:US
Practice Address - Phone:614-627-2000
Practice Address - Fax:614-546-3901
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423818208600000X
MDD0065010208600000X
NY236123208600000X
VA01012574352086S0129X
OH35.1382212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY757561Medicare PIN
NY08324PMedicare PIN