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General NPI Number Information
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NPI Number | 1336210178
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Entity Type | Individual
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Provider Name | MEKALA RAMGOPAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 01/05/2008
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Provider Practice Location Address
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Address Line | 2124 CAMP RD
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-2721
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Country | US
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Telephone | 718-327-0207
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Fax | 718-327-1225
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Provider Business Mailing Address
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Address Line | 82 REGENT DR
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City | LIDO BEACH
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State | NY
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Zip | 11561-4923
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Country | US
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Telephone | 516-431-8081
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Fax | 516-432-8484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 138691
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License Number State | NY
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