Provider Demographics
NPI:1316271588
Name:G. K. DWARAKANATH, MD LLC
Entity type:Organization
Organization Name:G. K. DWARAKANATH, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOPALA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DWARAKANATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-683-5115
Mailing Address - Street 1:290 BROADWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-6827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2134
Practice Address - Country:US
Practice Address - Phone:978-937-6460
Practice Address - Fax:978-937-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B76331Medicare UPIN