Provider Demographics
NPI:1841253234
Name:GOPALSWAMY, SABITHA R (MD)
Entity type:Individual
Prefix:
First Name:SABITHA
Middle Name:R
Last Name:GOPALSWAMY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-595-2300
Mailing Address - Fax:508-853-5226
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-595-2300
Practice Address - Fax:508-853-5226
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3170608OtherMEDICAID WELFARE
J18350OtherBLUE SHIELD HMO BLUE
52466OtherCHILDRENS MEDICAL SECURIT
784139OtherMVP HEALTH CARE
2045640OtherFIRST HEALTH
042472266OtherHEALTHCARE VALUE MANAGEME
0401728OtherEVERCARE
52466OtherHEALTHY START
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
32213OtherFALLON COMMUNITY HEALTH P
3922460OtherCIGNA HEALTH PLAN
J18350OtherBLUE SHIELD INDEMNITY
MA3170608Medicaid
7148596OtherAETNA US HEALTHCARE
AA1205OtherHARVARD PILGRIM HEALTHCAR
J18350OtherBLUE CARE ELECT
G53212Medicare UPIN
J18350OtherBLUE SHIELD HMO BLUE
AA1205OtherHARVARD PILGRIM HEALTHCAR