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NPI Code Detail

MEDICARE: DR. JEFFREY A KOPP MD

MEDICARE: DR. JEFFREY A 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
1207Q00000XFamily Medicine Physician025711CT

General Provider Information

NPI Number : 1659384733
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY A KOPP MD
Provider Business Mailing Address
First Line : 4 FARM SPRINGS RD
Second Line : PROHEALTH PHYSICIANS
City : FARMINGTON
State : CT
Zip : 06032-2573
Country : US
Telephone Number : 860-284-5200
Fax Number : 860-284-5333
Provider Business Practice Location Address
First Line : 1591 BOSTON POST RD
Second Line : SUITE 100
City : GUILFORD
State : CT
Zip : 06437-4335
Country : US
Telephone Number : 203-453-9911
Fax Number : 203-458-1905
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 01/14/2011

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