Provider Demographics
NPI:1760407050
Name:GOPAL, PAPAIAH (MD)
Entity Type:Individual
Prefix:
First Name:PAPAIAH
Middle Name:
Last Name:GOPAL
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 1:6 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2474
Mailing Address - Country:US
Mailing Address - Phone:978-825-8675
Mailing Address - Fax:978-745-9062
Practice Address - Street 1:1 DOVE AVENUE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-825-8675
Practice Address - Fax:978-745-9062
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73310208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
J10317OtherBCBS INDIVIDUAL
073310OtherTUFTS
2084790OtherUS HEALTH CARE
80639OtherHARVARD PILGRIM
MA3074714Medicaid
M18968OtherBCBS GROUP
M18968OtherBCBS GROUP
MA3074714Medicaid