Provider Demographics
NPI:1538116330
Name:SKOPETS, IRINA A (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:A
Last Name:SKOPETS
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 1:14321 POTOMAC HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3845
Mailing Address - Country:US
Mailing Address - Phone:410-303-4840
Mailing Address - Fax:240-780-9121
Practice Address - Street 1:16220 FREDERICK RD STE 206
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877
Practice Address - Country:US
Practice Address - Phone:410-303-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD314282084N0400X
VA01010592532084N0400X
MDD504072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD700400100Medicaid
MD490286Medicare ID - Type UnspecifiedMONTGOMERY COUNTY
MD653QMedicare ID - Type UnspecifiedBALTIMORE COUNTY
MD700400100Medicaid