Healthcare Provider Details

I. General information

NPI: 1265879118
Provider Name (Legal Business Name): RAVINDRA GOPAUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2013
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST MED-EM: MEDICINE-EMERGENCY MEDICINE CLINIC
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

PO BOX 980401 MED-EM: MEDICINE-EMERGENCY MEDICINE
RICHMOND VA
23298-0401
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4860
  • Fax: 804-828-4603
Mailing address:
  • Phone: 804-828-4860
  • Fax: 804-828-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101261314
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: