1053390203 NPI number — DR. VICTOR Y KOPYEV M.D.

Table of content: MELANIE BORON PHARMD (NPI 1194270546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053390203 NPI number — DR. VICTOR Y KOPYEV M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPYEV
Provider First Name:
VICTOR
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053390203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1949 STATE ROUTE 59
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44240-8124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-673-0505
Provider Business Mailing Address Fax Number:
330-673-8708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1949 STATE ROUTE 59
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44240-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-673-0505
Provider Business Practice Location Address Fax Number:
330-673-8708
Provider Enumeration Date:
01/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35074815 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100594 . This is a "KAIZER PERMANENTE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9379301 . This is a "MEDICARE PTAN GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 635 . This is a "SUMMA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P1482767 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Q001339 . This is a "HOMETOWN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4251121 . This is a "MEDICARE PTAN INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110233939 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000586847 . This is a "ANTHEM GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000586851 . This is a "ANTHEM INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2879532 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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