Healthcare Provider Details

I. General information

NPI: 1609862630
Provider Name (Legal Business Name): GOPALA DWARAKANATH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HOSPITAL DR
LOWELL MA
01852-1311
US

IV. Provider business mailing address

290 BROADWAY 104
METHUEN MA
01844-6827
US

V. Phone/Fax

Practice location:
  • Phone: 978-618-5550
  • Fax: 978-937-6842
Mailing address:
  • Phone: 978-683-5115
  • Fax: 978-683-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number50393
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9652
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number50393
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number9652
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: