Provider Demographics
NPI:1164428694
Name:KOPOLOW, LOUIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:E
Last Name:KOPOLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6216 PERTHSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3348
Mailing Address - Country:US
Mailing Address - Phone:301-897-7363
Mailing Address - Fax:
Practice Address - Street 1:8915 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1308
Practice Address - Country:US
Practice Address - Phone:301-963-0060
Practice Address - Fax:301-258-7482
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00167882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD48683OtherMAMSI
DC039483Medicare PIN
MDB92926Medicare UPIN