Provider Demographics
NPI:1154503373
Name:HAROLD COPANS MD INC
Entity Type:Organization
Organization Name:HAROLD COPANS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:COPANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-287-7060
Mailing Address - Street 1:5555 RESERVOIR DRIVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5195
Mailing Address - Country:US
Mailing Address - Phone:619-287-7060
Mailing Address - Fax:619-287-7078
Practice Address - Street 1:5555 RESERVOIR DRIVE
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5195
Practice Address - Country:US
Practice Address - Phone:619-287-7060
Practice Address - Fax:619-287-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37193207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A371930Medicaid
A28328Medicare UPIN
CAA37193Medicare PIN