Provider Demographics
NPI:1508841347
Name:SETH, KOPAL (MD)
Entity Type:Individual
Prefix:
First Name:KOPAL
Middle Name:
Last Name:SETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KOPAL
Other - Middle Name:
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-1900
Practice Address - Fax:602-933-1918
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220313208000000X, 2080P0204X
AZ365292080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2103869Medicaid
AZ217723Medicaid
AZ217723Medicaid
I31291Medicare UPIN
MA2103869Medicaid