Provider Demographics
NPI:1780616557
Name:KOP, SHELDON M (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:M
Last Name:KOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2087
Mailing Address - Country:US
Mailing Address - Phone:775-882-0430
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:2874 N CARSON ST STE 215
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1682
Practice Address - Country:US
Practice Address - Phone:775-445-5500
Practice Address - Fax:775-852-6902
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55902085R0202X
CAG541882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV30WCCBR04OtherMEDICARE PTAN
CAAX909XOtherMEDICARE PTAN
NV002013003Medicaid
NV300034706OtherRAILROAD MEDICARE
CAFS4913489OtherMEDICAL
NV300034706OtherRAILROAD MEDICARE