MEDICARE: VINCENT J KOPP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	27549	NC

General Provider Information

NPI Number	:	1063462398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT J KOPP MD

Provider Business Mailing Address
First Line	:	405 E KING ST
Second Line	:
City	:	EDENTON
State	:	NC
Zip	:	27932-2021
Country	:	US
Telephone Number	:	252-335-0531
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 N ROAD ST
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3353
Country	:	US
Telephone Number	:	252-335-0531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	03/07/2023

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