Provider Demographics
NPI:1578301487
Name:VETERAN PROVIDER GROUP
Entity type:Organization
Organization Name:VETERAN PROVIDER GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-257-4264
Mailing Address - Street 1:3403 GLENMEDE LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9123
Mailing Address - Country:US
Mailing Address - Phone:301-257-4264
Mailing Address - Fax:
Practice Address - Street 1:20 BRIARCREST SQ STE 208
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2331
Practice Address - Country:US
Practice Address - Phone:301-257-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty