1649295288 NPI number — MRS. USHA M GOPAL MD

Table of content: MRS. USHA M GOPAL MD (NPI 1649295288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649295288 NPI number — MRS. USHA M GOPAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOPAL
Provider First Name:
USHA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649295288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
633 E RAY RD # 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85296-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-497-3946
Provider Business Mailing Address Fax Number:
480-497-3947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
633 E RAY RD # 128
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85296-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-497-3946
Provider Business Practice Location Address Fax Number:
480-497-3947
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  33590 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 941858 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: I34013 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICARE UPIN".