Provider Demographics
NPI:1972538437
Name:BATRA, GOPAL KRISHAN (MD)
Entity Type:Individual
Prefix:
First Name:GOPAL
Middle Name:KRISHAN
Last Name:BATRA
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 1:912 TEAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1332
Mailing Address - Country:US
Mailing Address - Phone:310-786-7100
Mailing Address - Fax:310-472-4459
Practice Address - Street 1:912 TEAKWOOD RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-1332
Practice Address - Country:US
Practice Address - Phone:310-786-7100
Practice Address - Fax:310-472-4459
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A297390OtherMEDICAL PPIN #
CA00A297390OtherMEDICAL PPIN #
CAA25862Medicare UPIN