Provider Demographics
NPI:1255517371
Name:RENE KOPPEL, M.D. - A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:RENE KOPPEL, M.D. - A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-454-1885
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 1:502 RUE DE SANTE
Practice Address - Street 2:SUITE #303
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5424
Practice Address - Country:US
Practice Address - Phone:985-651-4432
Practice Address - Fax:985-651-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022658207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CF01Medicare PIN