Healthcare Provider Details

I. General information

NPI: 1861430795
Provider Name (Legal Business Name): GOPAL VEERARAGHAVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-703-8000
  • Fax: 570-703-7418
Mailing address:
  • Phone: 570-703-8000
  • Fax: 570-703-7418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD469765
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00000522
Identifier TypeOTHER
Identifier StateWV
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier110226578
Identifier TypeOTHER
Identifier StateWV
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier001720584
Identifier TypeOTHER
Identifier StateWV
Identifier IssuerBCBS
# 4
Identifier1806415000
Identifier TypeMEDICAID
Identifier StateWV
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: