Healthcare Provider Details

I. General information

NPI: 1942245659
Provider Name (Legal Business Name): G DAVID K HOPPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 R HIGHLAND AVE
SALEM MA
01970
US

IV. Provider business mailing address

114 R HIGHLAND AVE
SALEM MA
01970
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-3711
  • Fax: 978-745-6208
Mailing address:
  • Phone: 978-745-3711
  • Fax: 978-745-6208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number34476
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: