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General NPI Number Information
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NPI Number | 1134306731
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Entity Type | Organization
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Legal Business Name | PETER L KOPELSON MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 414 N CAMDEN DR SUITE 640
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4532
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Country | US
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Telephone | 310-271-7400
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Fax | 310-271-0003
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Provider Business Mailing Address
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Address Line | 414 N CAMDEN DR SUITE 640
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4532
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Country | US
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Telephone | 310-271-7400
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Fax | 310-271-0003
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Authorized Official
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Title or Position | OWNER
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Name | PETER L KOPELSON
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Credential | M.D.
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Telephone | 310-271-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G70622
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License Number State | CA
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