Provider Demographics
NPI:1679584379
Name:KRISHNAN GOPAL MD
Entity Type:Organization
Organization Name:KRISHNAN GOPAL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-466-7450
Mailing Address - Street 1:575 COAL VALLEY ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025
Mailing Address - Country:US
Mailing Address - Phone:412-466-7450
Mailing Address - Fax:412-466-0588
Practice Address - Street 1:575 COAL VALLEY ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025
Practice Address - Country:US
Practice Address - Phone:412-466-7450
Practice Address - Fax:412-466-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038578L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007104530002Medicaid
PA0007104530002Medicaid