Healthcare Provider Details

I. General information

NPI: 1497069595
Provider Name (Legal Business Name): KATELYN S KOPCSAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN R SMITHLING

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN STREET 4TH FL, SUITE B
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FLOOR
SPRINGFIELD MA
01199-1619
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7045
  • Fax: 413-794-5857
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number270413
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberLP02067
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD042075
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number270413
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: