MEDICARE: DR. SARASWATHI GOPALAN NAIR 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
1	207Q00000X	Family Medicine Physician	055822	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00477554	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	52222832-001	OTHER	GA	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	52222832-002	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1851380661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARASWATHI GOPALAN NAIR MD

Provider Business Mailing Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:	JBSA FORT SAM HOUSTON
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-539-0958
Fax Number	:	210-521-2574

Provider Business Practice Location Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-539-0958
Fax Number	:	210-521-2574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	08/02/2021

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