Healthcare Provider Details

I. General information

NPI: 1174232144
Provider Name (Legal Business Name): EVA KOTSOPOULOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SILVER ST
WATERVILLE ME
04901-6668
US

IV. Provider business mailing address

PO BOX 1380
SARANAC LAKE NY
12983-7380
US

V. Phone/Fax

Practice location:
  • Phone: 207-922-3222
  • Fax:
Mailing address:
  • Phone: 518-897-4725
  • Fax: 518-897-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number421968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: