Provider Demographics
NPI:1245282417
Name:KOPIN, ELIZABETH A (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:KOPIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 MLK JR BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-755-4861
Mailing Address - Fax:508-752-1392
Practice Address - Street 1:100 MLK JR BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-755-4861
Practice Address - Fax:508-752-1392
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA56794207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
99803603OtherNETWORK HEALTH
13922OtherHARVARD PILGRIM
MAJ06071OtherBCBS
0010743OtherNEIGHBORHOOD HEALTH
MA3143554Medicaid
26485OtherFALLON
056794OtherTUFTS
26485OtherFALLON
MA3143554Medicaid