Provider Demographics
NPI:1134198849
Name:KOPP, DAVID WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:KOPP
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 1:420 CROSS KEYS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3506
Mailing Address - Country:US
Mailing Address - Phone:585-223-4620
Mailing Address - Fax:585-223-7447
Practice Address - Street 1:420 CROSS KEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3506
Practice Address - Country:US
Practice Address - Phone:585-223-4620
Practice Address - Fax:585-223-7447
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202063-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018028810001Medicaid
PA0018028810001Medicaid
NYCC2342Medicare ID - Type Unspecified
G46660Medicare UPIN
NYRB5178Medicare PIN