Healthcare Provider Details

I. General information

NPI: 1972793420
Provider Name (Legal Business Name): MAHESH SRISAILAPPA GOPASETTY MBBS, MS, MRCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST CSB 404
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

45 SYCAMORE AVE APT 523
CHARLESTON SC
29407-6710
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3368
  • Fax:
Mailing address:
  • Phone: 843-792-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberSCLL29704
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: