Healthcare Provider Details

I. General information

NPI: 1477637239
Provider Name (Legal Business Name): BARBARA ELZBIETA KUCEWICZ KOPYTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 SAND MOUNTAIN DRIVE SOUTHEAST
ALBERTVILLE AL
35950
US

IV. Provider business mailing address

312 SAND MOUNTAIN DRIVE SOUTHEAST
ALBERTVILLE AL
35950
US

V. Phone/Fax

Practice location:
  • Phone: 256-891-4577
  • Fax: 256-891-4919
Mailing address:
  • Phone: 256-891-4577
  • Fax: 256-891-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00021174
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD062147L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: