Provider Demographics
NPI:1316171762
Name:GOPAL, PALLAVI PADMAPRIYA (MD)
Entity type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:PADMAPRIYA
Last Name:GOPAL
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 1:275 MARCELLA LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2249
Mailing Address - Country:US
Mailing Address - Phone:267-325-4634
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST # EP2-631
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-6424
Practice Address - Fax:203-785-3585
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57170207ZP0101X, 207ZN0500X
PAMD444701207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology