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Individual

BALAJI GOPIDASAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.B.B.S.

Contact information

Practice address
620 MADISON ST, SYRACUSE, NY 13210-2319
(315) 426-3630
Mailing address
770 MAPLE RD, APPT # 1B, WILLIAMSVILLE, NY 14221-3249

Taxonomy

Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
L2956
AL

Other

Enumeration date
06/19/2008
Last updated
06/16/2010
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