Provider Demographics
NPI:1609922400
Name:GOPALAN, RAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RAM
Middle Name:
Last Name:GOPALAN
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 1:10333 BRITTENFORD DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1862
Mailing Address - Country:US
Mailing Address - Phone:703-716-3343
Mailing Address - Fax:
Practice Address - Street 1:1715 N GEORGE MASON DR
Practice Address - Street 2:SUITE # 409
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3609
Practice Address - Country:US
Practice Address - Phone:703-243-5960
Practice Address - Fax:703-243-5961
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010492492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007106751Medicaid
VA007106751Medicaid
VAG0689227Medicare ID - Type Unspecified