Provider Demographics
NPI: | 1558369983 |
---|---|
Name: | COPLIN, BRUCE E (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | BRUCE |
Middle Name: | E |
Last Name: | COPLIN |
Suffix: | |
Gender: | M |
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: | 2 PALISADES DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBANY |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12205-1438 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-458-2000 |
Mailing Address - Fax: | 518-458-1524 |
Practice Address - Street 1: | 2 PALISADES DR |
Practice Address - Street 2: | |
Practice Address - City: | ALBANY |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12205-1438 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-458-2000 |
Practice Address - Fax: | 518-458-1524 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-11 |
Last Update Date: | 2012-08-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 147525 | 207RC0000X, 207UN0901X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 01034317 | Medicaid | |
VT | 1003578 | Medicaid | |
VT | 1003578 | Medicaid | |
NY | RA2931 | Medicare PIN |