Provider Demographics
NPI:1700853843
Name:KOPLIN, CARL (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:KOPLIN
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:PO BOX 167
Mailing Address - Street 2:
Mailing Address - City:BARKHAMSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06063-0167
Mailing Address - Country:US
Mailing Address - Phone:860-238-7252
Mailing Address - Fax:
Practice Address - Street 1:69 PLEASANT VALLEY RD # 3A
Practice Address - Street 2:
Practice Address - City:BARKHAMSTED
Practice Address - State:CT
Practice Address - Zip Code:06063-4008
Practice Address - Country:US
Practice Address - Phone:860-238-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080129757OtherMEDICARE RAIL ROAD
CT279747OtherNATIONAL BOARD OF MEDICAL EXAMINERS
CT001272467Medicaid
CTB83926Medicare UPIN
CT080001260Medicare PIN