Provider Demographics
NPI:1497764633
Name:RENE KOPPEL, M.D. - A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RENE KOPPEL, M.D. - A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-454-1885
Mailing Address - Street 1:3640 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4230
Mailing Address - Country:US
Mailing Address - Phone:504-454-1885
Mailing Address - Fax:504-454-0925
Practice Address - Street 1:3640 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4230
Practice Address - Country:US
Practice Address - Phone:504-454-1885
Practice Address - Fax:504-454-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty