Provider Demographics
NPI:1851473045
Name:KOPTCHAK, ABBIE L (PA C)
Entity Type:Individual
Prefix:MS
First Name:ABBIE
Middle Name:L
Last Name:KOPTCHAK
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:L
Other - Last Name:MCCAMLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:CREDENTIALS DEPT
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:210 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-1948
Practice Address - Country:US
Practice Address - Phone:814-342-5402
Practice Address - Fax:814-342-0598
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052734363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108625Medicare PIN
Q76921Medicare UPIN