Healthcare Provider Details

I. General information

NPI: 1922363894
Provider Name (Legal Business Name): DHARMESH GOPALAKRISHNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-8935
Mailing address:
  • Phone: 216-444-2200
  • Fax: 844-455-5069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number308886
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number125411
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: