Provider Demographics
NPI:1730257080
Name:ALEXANDER KOPP, MD, PC
Entity type:Organization
Organization Name:ALEXANDER KOPP, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-527-6200
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:STE 542
Mailing Address - City:NEWTON LOWER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1624
Mailing Address - Country:US
Mailing Address - Phone:617-527-6200
Mailing Address - Fax:617-965-5894
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:STE 542
Practice Address - City:NEWTON LOWER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02462-1624
Practice Address - Country:US
Practice Address - Phone:617-527-6200
Practice Address - Fax:617-965-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110217745OtherRAIL ROAD MEDICARE
MA9702971Medicaid
MA0000869Medicare PIN