1780616557 NPI number — SHELDON M KOP MD

Table of content: SHELDON M KOP MD (NPI 1780616557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780616557 NPI number — SHELDON M KOP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOP
Provider First Name:
SHELDON
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1780616557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2087
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89702-2087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-882-0430
Provider Business Mailing Address Fax Number:
775-852-6902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2874 N CARSON ST STE 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89706-1682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-445-5500
Provider Business Practice Location Address Fax Number:
775-852-6902
Provider Enumeration Date:
07/06/2006

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: 2085R0202X , with the licence number:  5590 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: G54188 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30WCCBR04 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: AX909X . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 002013003 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300034706 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: FS4913489 . This is a "MEDICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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