Healthcare Provider Details

I. General information

NPI: 1730257080
Provider Name (Legal Business Name): ALEXANDER KOPP, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST STE 542
NEWTON LOWER FALLS MA
02462-1624
US

IV. Provider business mailing address

2000 WASHINGTON ST STE 542
NEWTON LOWER FALLS MA
02462-1624
US

V. Phone/Fax

Practice location:
  • Phone: 617-527-6200
  • Fax: 617-965-5894
Mailing address:
  • Phone: 617-527-6200
  • Fax: 617-965-5894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER KOPP
Title or Position: PRESIDENT
Credential: MD
Phone: 617-527-6200