Provider Demographics
NPI:1174588107
Name:GOPAL, ALOK (MD)
Entity type:Individual
Prefix:
First Name:ALOK
Middle Name:
Last Name:GOPAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD EXECUTIVE PLAZA 1
Mailing Address - Street 2:STE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:703-738-4331
Mailing Address - Fax:
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:STE 420
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-536-1616
Practice Address - Fax:540-536-6464
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238002207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010192064Medicaid
VA34801OtherANTHEM
H65149Medicare UPIN
VA008491W58Medicare ID - Type Unspecified