Provider Demographics
NPI:1023088325
Name:BOPPANA, MEERA S (MD)
Entity type:Individual
Prefix:MRS
First Name:MEERA
Middle Name:S
Last Name:BOPPANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 38 UNION TURNPIKE
Mailing Address - Street 2:#12 E
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-441-0660
Mailing Address - Fax:718-847-1538
Practice Address - Street 1:104 15 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416
Practice Address - Country:US
Practice Address - Phone:718-441-0660
Practice Address - Fax:718-847-1538
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01305908Medicaid
01786GMedicare ID - Type Unspecified
E94332Medicare UPIN