Provider Demographics
NPI:1962551242
Name:RANA MUKKAVILLI, GOPI RANA (MD)
Entity type:Individual
Prefix:DR
First Name:GOPI
Middle Name:RANA
Last Name:RANA MUKKAVILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HAMILTON AVE.
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-1986
Mailing Address - Country:US
Mailing Address - Phone:609-599-5050
Mailing Address - Fax:609-599-4318
Practice Address - Street 1:601 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1986
Practice Address - Country:US
Practice Address - Phone:609-599-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179769207R00000X
NJ25MA07228100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine