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NPI Code Detail

MEDICARE: GOPI MUKKAVILLI, MD

MEDICARE: GOPI MUKKAVILLI, MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician
2207QA0401XAddiction Medicine (Family Medicine) Physician
3208VP0000XPain Medicine Physician
4207RS0012XSleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1023379229
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOPI MUKKAVILLI, MD
Provider Business Mailing Address
First Line : 4065 QUAKERBRIDGE RD
Second Line :
City : PRINCETON JUNCTION
State : NJ
Zip : 08550-5243
Country : US
Telephone Number : 609-482-3701
Fax Number : 609-482-3702
Provider Business Practice Location Address
First Line : 4065 QUAKERBRIDGE RD
Second Line :
City : PRINCETON JUNCTION
State : NJ
Zip : 08550-5243
Country : US
Telephone Number : 609-482-3701
Fax Number : 609-482-3702
Authorized Official
Title or Position : MANAGER
Name : MICHELE NAOMI
Credential :
Telephone Number : 609-482-3701
Provider Enumeration Date : 06/04/2012
Last Update Date : 06/04/2012

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