Provider Demographics
NPI:1528065364
Name:PRAKASH, GOKUL VR (MD)
Entity type:Individual
Prefix:
First Name:GOKUL
Middle Name:VR
Last Name:PRAKASH
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 1:575 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5924
Mailing Address - Country:US
Mailing Address - Phone:978-682-2310
Mailing Address - Fax:978-682-8206
Practice Address - Street 1:575 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5924
Practice Address - Country:US
Practice Address - Phone:978-682-2310
Practice Address - Fax:978-682-8206
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42433208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2087189Medicaid
A54195Medicare UPIN
MA2087189Medicaid
MAD24021Medicare ID - Type Unspecified