Provider Demographics
NPI:1851332563
Name:GOPALAN, RAMANA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RAMANA
Middle Name:
Last Name:GOPALAN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 MAIDEN CHOICE LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5943
Mailing Address - Country:US
Mailing Address - Phone:410-747-5888
Mailing Address - Fax:410-747-9648
Practice Address - Street 1:716 MAIDEN CHOICE LN
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-5943
Practice Address - Country:US
Practice Address - Phone:410-747-5888
Practice Address - Fax:410-747-9648
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD51228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7363900100Medicaid
MD680QMedicare ID - Type Unspecified
MD7363900100Medicaid