Basic Information
| Provider Information | |||||||||
| NPI: | 1962551242 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANA MUKKAVILLI | ||||||||
| FirstName: | GOPI | ||||||||
| MiddleName: | RANA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 HAMILTON AVE. | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086291986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095995050 | ||||||||
| FaxNumber: | 2126847905 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 HAMILTON AVE | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086291986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095995050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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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 | 179769 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA07228100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.