Provider Demographics
NPI:1306952635
Name:MOHAPELOA, GUGU (MD)
Entity type:Individual
Prefix:
First Name:GUGU
Middle Name:
Last Name:MOHAPELOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 BORDENTOWN AVE
Mailing Address - Street 2:#18
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1851
Mailing Address - Country:US
Mailing Address - Phone:732-727-4700
Mailing Address - Fax:732-727-4734
Practice Address - Street 1:1145 BORDENTOWN AVE
Practice Address - Street 2:#18
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1851
Practice Address - Country:US
Practice Address - Phone:732-727-4700
Practice Address - Fax:732-727-4734
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066841207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7773706Medicaid
NJ7773706Medicaid
005277Medicare ID - Type Unspecified