Basic Information
| Provider Information | |||||||||
| NPI: | 1841253234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOPALSWAMY | ||||||||
| FirstName: | SABITHA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET12 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952300 | ||||||||
| FaxNumber: | 5088535226 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 NEPONSET ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952300 | ||||||||
| FaxNumber: | 5088535226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 150741 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3170608 | 01 | MEDICAID WELFARE | OTHER | J18350 | 01 | BLUE SHIELD HMO BLUE | OTHER | 52466 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 784139 | 01 | MVP HEALTH CARE | OTHER | 2045640 | 01 | FIRST HEALTH | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 0401728 | 01 | EVERCARE | OTHER | 52466 | 01 | HEALTHY START | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 32213 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 3922460 | 01 | CIGNA HEALTH PLAN | OTHER | J18350 | 01 | BLUE SHIELD INDEMNITY | OTHER | 3170608 | 05 | MA | MEDICAID | 7148596 | 01 | AETNA US HEALTHCARE | OTHER | AA1205 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | J18350 | 01 | BLUE CARE ELECT | OTHER |