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General NPI Number Information
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NPI Number | 1235407602
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Entity Type | Organization
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Legal Business Name | NEDU GOPALA, M.D., P.C.
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 3250 N 19TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47804-1444
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Country | US
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Telephone | 812-460-0109
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 N 19TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47804-1444
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Country | US
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Telephone | 812-460-0109
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. NEDU GOPALA
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Credential | M.D.
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Telephone | 812-460-0109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01040752A
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License Number State | IN
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