Provider Demographics
NPI:1700184587
Name:IRINA A. SKOPETS, MD, PA
Entity Type:Organization
Organization Name:IRINA A. SKOPETS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKOPETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-315-0514
Mailing Address - Street 1:14321 POTOMAC HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3845
Mailing Address - Country:US
Mailing Address - Phone:410-303-4840
Mailing Address - Fax:240-780-9121
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:SUITE 206
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:410-303-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00507042084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD70040010000Medicaid
MD70040010001Medicaid
MD70040010000Medicaid