1255517371 NPI number — RENE KOPPEL, M.D. - A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1255517371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255517371 NPI number — RENE KOPPEL, M.D. - A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENE KOPPEL, M.D. - A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1255517371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3640 HOUMA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-4230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-454-1885
Provider Business Mailing Address Fax Number:
504-454-0925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 RUE DE SANTE
Provider Second Line Business Practice Location Address:
SUITE #303
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068-5424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-651-4432
Provider Business Practice Location Address Fax Number:
985-651-4474
Provider Enumeration Date:
01/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KOPPEL
Authorized Official First Name:
RENE
Authorized Official Middle Name:
Authorized Official Title or Position:
DERMATOLOGIST
Authorized Official Telephone Number:
504-454-1885

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  022658 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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