Provider Demographics
NPI:1619002698
Name:KOPLIN, LAWRENCE MARK (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MARK
Last Name:KOPLIN
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 NORTH ROXBURY DRIVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-277-3223
Mailing Address - Fax:310-278-9138
Practice Address - Street 1:465 NORTH ROXBURY DRIVE
Practice Address - Street 2:SUITE 800
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4211
Practice Address - Country:US
Practice Address - Phone:310-277-3223
Practice Address - Fax:310-278-9138
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG035647174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91704Medicare UPIN
CAA91704Medicare UPIN