Provider Demographics
NPI:1619124419
Name:GOOPTA, MICHAEL S (L AC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:GOOPTA
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6014
Mailing Address - Country:US
Mailing Address - Phone:828-719-1819
Mailing Address - Fax:
Practice Address - Street 1:363 DANIEL DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-6014
Practice Address - Country:US
Practice Address - Phone:828-719-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist