MEDICARE: DR. DAVID WILLIAM KOPP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	202063-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134198849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WILLIAM KOPP MD

Provider Business Mailing Address
First Line	:	420 CROSS KEYS OFFICE PARK
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-3506
Country	:	US
Telephone Number	:	585-223-4620
Fax Number	:	585-223-7447

Provider Business Practice Location Address
First Line	:	420 CROSS KEYS OFFICE PARK
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-3506
Country	:	US
Telephone Number	:	585-223-4620
Fax Number	:	585-223-7447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	08/28/2022

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