Provider Demographics
NPI:1588624464
Name:GOPAL, SUMA RAMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMA
Middle Name:RAMESH
Last Name:GOPAL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:149 STONE MOSS LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6806
Mailing Address - Country:US
Mailing Address - Phone:336-785-9855
Mailing Address - Fax:
Practice Address - Street 1:190 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-768-3296
Practice Address - Fax:336-794-8668
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine