Provider Demographics
NPI:1336210178
Name:RAMGOPAL, MEKALA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEKALA
Middle Name:
Last Name:RAMGOPAL
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 1:82 REGENT DR
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4923
Mailing Address - Country:US
Mailing Address - Phone:516-431-8081
Mailing Address - Fax:516-432-8484
Practice Address - Street 1:2124 CAMP RD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2721
Practice Address - Country:US
Practice Address - Phone:718-327-0207
Practice Address - Fax:718-327-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138691207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00394069Medicaid
NY97422GMedicare PIN
NYA99328Medicare UPIN
NY09A291L161Medicare PIN