Provider Demographics
NPI:1477558807
Name:ANASZ-KOPECKA, BEATA (MD)
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:
Last Name:ANASZ-KOPECKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 SE NORTON LN
Mailing Address - Street 2:STE A
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8484
Mailing Address - Country:US
Mailing Address - Phone:503-472-9002
Mailing Address - Fax:503-474-0157
Practice Address - Street 1:375 SE NORTON LN
Practice Address - Street 2:STE A
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8484
Practice Address - Country:US
Practice Address - Phone:503-472-9002
Practice Address - Fax:503-474-0157
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277797Medicaid
OR277797Medicaid
ORG74478Medicare UPIN