Provider Demographics
NPI:1023115334
Name:GOEL, DINESH KUMAR (MDPA)
Entity type:Individual
Prefix:DR
First Name:DINESH
Middle Name:KUMAR
Last Name:GOEL
Suffix:
Gender:M
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16594
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39236-6594
Mailing Address - Country:US
Mailing Address - Phone:601-957-5150
Mailing Address - Fax:601-957-5161
Practice Address - Street 1:6050 I-55 NORTH EAST FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-957-5150
Practice Address - Fax:601-957-5161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS640599749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSB66109Medicare UPIN