Provider Demographics
NPI:1457329450
Name:RAMGOPAL, MOTI N (MD)
Entity type:Individual
Prefix:MR
First Name:MOTI
Middle Name:N
Last Name:RAMGOPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 E MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-7148
Mailing Address - Country:US
Mailing Address - Phone:772-464-9746
Mailing Address - Fax:772-464-9750
Practice Address - Street 1:356 E MIDWAY RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-7148
Practice Address - Country:US
Practice Address - Phone:772-464-9746
Practice Address - Fax:772-464-9750
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70180207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251313700Medicaid
FL251313700Medicaid
FL32822BMedicare PIN
FL32822BMedicare PIN