Provider Demographics
NPI:1053300806
Name:KOPELSON, PETER L (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:KOPELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:SUITE 640
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-271-7400
Mailing Address - Fax:310-271-0003
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:SUITE 640
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-271-7400
Practice Address - Fax:310-271-0003
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2014-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG70622207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18106OtherGROUP ID
F59594Medicare UPIN
CAW18106OtherGROUP ID