Provider Demographics
NPI:1881337541
Name:GOPALAKRISHNAN, MAITHILI (MD)
Entity type:Individual
Prefix:DR
First Name:MAITHILI
Middle Name:
Last Name:GOPALAKRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAITHILI
Other - Middle Name:
Other - Last Name:GOPAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 HARRISON ST STE N
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3188
Mailing Address - Country:US
Mailing Address - Phone:315-464-1500
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:732-516-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program