Provider Demographics
NPI:1578607560
Name:GOPALAN, MARCUS SUSEEL
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:SUSEEL
Last Name:GOPALAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 WALKERS CROFT WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5236
Mailing Address - Country:US
Mailing Address - Phone:202-631-1064
Mailing Address - Fax:
Practice Address - Street 1:6273 WALKERS CROFT WAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5236
Practice Address - Country:US
Practice Address - Phone:202-631-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor