Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 240115 | MA |
N | 111NI0900X | Internist | 240115 | MA |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 240115 | MA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 240115 | MA |
NPI | 1689850752 |
---|---|
Provider Name | Dr. Deepa Mangalat Gopal |
First Address | Boston, MA 02119-3791 |
Second Address | Boston, MA 02118-2309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2008 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110097682A | (05) | MA |