Provider Demographics
NPI:1700228715
Name:GOPALAKRISHNAN, PALANIVELRAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:PALANIVELRAJU
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 1:1850 ASHLEY CROSSING LN
Mailing Address - Street 2:17 B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5711
Mailing Address - Country:US
Mailing Address - Phone:843-847-7393
Mailing Address - Fax:
Practice Address - Street 1:96 JONATHAN LUCAS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-6110
Practice Address - Country:US
Practice Address - Phone:843-792-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36122390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program