Provider Demographics
NPI:1841237559
Name:KOPP, LAURA JANE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:KOPP
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 1:220 LINDEN OAKS
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2839
Mailing Address - Country:US
Mailing Address - Phone:585-381-4982
Mailing Address - Fax:585-381-1821
Practice Address - Street 1:220 LINDEN OAKS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2839
Practice Address - Country:US
Practice Address - Phone:585-381-4982
Practice Address - Fax:585-381-1821
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01817069Medicaid
NY01817069Medicare ID - Type Unspecified
NY01817069Medicaid
NYH37935Medicare UPIN
NYCC6037Medicare ID - Type Unspecified