Provider Demographics
NPI:1962503433
Name:RAHMAN, GOPA (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPA
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GOPA
Other - Middle Name:
Other - Last Name:RAHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:243 NORTH RD SUITE 201N
Mailing Address - Street 2:243 NORTH RD SUITE 201N
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-454-0370
Mailing Address - Fax:845-454-6017
Practice Address - Street 1:243 NORTH RD SUITE 201N
Practice Address - Street 2:243 NORTH RD SUITE 201
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-454-0370
Practice Address - Fax:845-454-6017
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060019079OtherRAILROAD MEDICARE
NY01396625Medicaid
NY060019079OtherRAILROAD MEDICARE
NY01396625Medicaid