Provider Demographics
NPI:1295786689
Name:GOPAL, GNANAPRAKASH (MD)
Entity type:Individual
Prefix:
First Name:GNANAPRAKASH
Middle Name:
Last Name:GOPAL
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 1:701 W UNION BLVD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2649 SCHOENERSVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7326
Practice Address - Country:US
Practice Address - Phone:484-884-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043751L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080194789OtherRAILROAD MEDICARE
PA20029022OtherAMERIHEALTH MERCY
PAP005058OtherGATEWAY HEALTH PLAN
PA520682OtherAETNA
PA98280OtherLOCAL 825 FUND
PA150486OtherTHREE RIVERS/UNISON
PA50012813OtherCAPITAL BLUE CROSS
PA690625OtherAMERIHEALTH (IBC)
PA001946890Medicaid
PA690625OtherKEYSTONE CENTRAL
PA690625OtherHIGHMARK BLUE SHIELD
PA79407OtherGEISINGER HEALTH PLAN
PA0525380000OtherKEYSTONE EAST
PA98280OtherLOCAL 825 FUND
PAF06320Medicare UPIN