Provider Demographics
NPI:1780676643
Name:GOPAL, KRISHNAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNAN
Middle Name:A
Last Name:GOPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:STE 301
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-466-7450
Mailing Address - Fax:412-466-0588
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:STE 301
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-466-7450
Practice Address - Fax:412-466-0588
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-038578L208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007104530002Medicaid
PA1679584379Medicare NSC
PA0007104530002Medicaid
PA1780676643Medicare NSC
PA400843U7UMedicare PIN