Provider Demographics
NPI:1730307000
Name:MEKALA RAMGOPAL PC
Entity Type:Organization
Organization Name:MEKALA RAMGOPAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEKALA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMGOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-431-2656
Mailing Address - Street 1:82 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4923
Mailing Address - Country:US
Mailing Address - Phone:516-431-2656
Mailing Address - Fax:516-432-8484
Practice Address - Street 1:2124 CAMP RD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2721
Practice Address - Country:US
Practice Address - Phone:516-431-2656
Practice Address - Fax:516-432-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138691207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00394069Medicaid
NY97422Medicare PIN
NY00394069Medicaid
NYA99328Medicare UPIN