Provider Demographics
NPI:1609862630
Name:DWARAKANATH, GOPALA (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPALA
Middle Name:
Last Name:DWARAKANATH
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 1:290 BROADWAY 104
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-6827
Mailing Address - Country:US
Mailing Address - Phone:978-683-5115
Mailing Address - Fax:978-683-7337
Practice Address - Street 1:2 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1311
Practice Address - Country:US
Practice Address - Phone:978-618-5550
Practice Address - Fax:978-937-6842
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50393207L00000X, 207LP2900X
NH9652207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20-01286OtherEVERCARE
MA705679OtherTHP
MA3011330Medicaid
MAJ05943OtherBCBSMA
MA20-00178OtherUHC
MA26794OtherFCHP
MA275207OtherHPHC
NH0108621Y0MA01OtherANTHEM
NH30005579Medicaid
MA8984154-001OtherCIGNA
MA0003232OtherNHP
MA4451978OtherAETNA
NH0108621Y0MA01OtherANTHEM
MAJ05943Medicare ID - Type UnspecifiedMEDICARE
NH30005579Medicaid