Provider Demographics
NPI:1811201841
Name:SREEKUMARAN NAIR, GOPAKUMAR
Entity Type:Individual
Prefix:
First Name:GOPAKUMAR
Middle Name:
Last Name:SREEKUMARAN NAIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3302
Mailing Address - Country:US
Mailing Address - Phone:508-941-7000
Mailing Address - Fax:508-941-6299
Practice Address - Street 1:680 CENTER ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3302
Practice Address - Country:US
Practice Address - Phone:508-941-7000
Practice Address - Fax:508-941-6299
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253991207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine