Provider Demographics
NPI:1326092883
Name:KOPYNEC, SUSAN D (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:KOPYNEC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 REGIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9796
Mailing Address - Country:US
Mailing Address - Phone:910-295-4222
Mailing Address - Fax:910-295-1578
Practice Address - Street 1:7 REGIONAL CIR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9796
Practice Address - Country:US
Practice Address - Phone:910-295-4222
Practice Address - Fax:910-295-1578
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE2976OtherMEDCOST
NCS57121Medicare UPIN
NC2752777EMedicare ID - Type UnspecifiedMEDICARE