Provider Demographics
NPI:1225259757
Name:KOPP, JUDY L (RD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:KOPP
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182255
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-2255
Mailing Address - Country:US
Mailing Address - Phone:614-430-5712
Mailing Address - Fax:614-430-5742
Practice Address - Street 1:285 E STATE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-0983
Practice Address - Country:US
Practice Address - Phone:614-460-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1432133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
KOMT02321Medicare ID - Type Unspecified