Provider Demographics
NPI:1649230681
Name:GOPALAKRISHNAN, MARATI (MD)
Entity Type:Individual
Prefix:
First Name:MARATI
Middle Name:
Last Name:GOPALAKRISHNAN
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 1:1213 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2831
Mailing Address - Country:US
Mailing Address - Phone:716-895-6200
Mailing Address - Fax:
Practice Address - Street 1:1213 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14211-2831
Practice Address - Country:US
Practice Address - Phone:716-895-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000502751003OtherBLUE CROSS
NY0010066202OtherUNIVERA
NY0400293OtherINDEPENDENT HEALTH
NY0400293OtherINDEPENDENT HEALTH