Provider Demographics
NPI:1427178052
Name:VERNICK & GOPAL,LLC
Entity type:Organization
Organization Name:VERNICK & GOPAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-383-6800
Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-383-6800
Mailing Address - Fax:617-383-6801
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-383-6800
Practice Address - Fax:617-383-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9719768Medicaid
MAM21428Medicare PIN
DB5229Medicare PIN