Healthcare Provider Details

I. General information

NPI: 1154586378
Provider Name (Legal Business Name): JEFFREY BURNETT KOPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR, NIH BDG 10, 3N116
BETHESDA MD
20892-1268
US

IV. Provider business mailing address

5510 LINCOLN ST
BETHESDA MD
20817-3354
US

V. Phone/Fax

Practice location:
  • Phone: 301-594-3403
  • Fax: 301-402-0014
Mailing address:
  • Phone: 301-594-3403
  • Fax: 301-402-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0038010
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: