=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760407050
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAPAIAH GOPAL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 323 LOWELL ST
-----------------------------------------------------
City | ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01810-4659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-794-1946
-----------------------------------------------------
Fax | 978-975-3925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 MAPLEWOOD RD
-----------------------------------------------------
City | MIDDLETON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01949-2474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-825-8675
-----------------------------------------------------
Fax | 978-745-9062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 73310
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------