Provider Demographics
NPI:1932417987
Name:GOPAL, SARASWATHI (MD)
Entity Type:Individual
Prefix:
First Name:SARASWATHI
Middle Name:
Last Name:GOPAL
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 1:2479 BURNT LEAF LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2806
Mailing Address - Country:US
Mailing Address - Phone:917-359-9459
Mailing Address - Fax:
Practice Address - Street 1:2479 BURNT LEAF LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2806
Practice Address - Country:US
Practice Address - Phone:917-359-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH095360207R00000X, 207RN0300X
FLME117505207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013697100Medicaid
FLHZ896ZMedicare PIN