Provider Demographics
NPI:1861459547
Name:KOPPEL, RENE NONE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:NONE
Last Name:KOPPEL
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 1:3640 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4230
Mailing Address - Country:US
Mailing Address - Phone:504-454-1885
Mailing Address - Fax:504-454-0925
Practice Address - Street 1:3640 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4230
Practice Address - Country:US
Practice Address - Phone:504-454-1885
Practice Address - Fax:504-454-0925
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011353207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA52031Medicare ID - Type Unspecified
LAB89498Medicare UPIN