Provider Demographics
NPI:1154536639
Name:KOPPEL, MARCELO H (MD)
Entity type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:H
Last Name:KOPPEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCEL
Other - Middle Name:
Other - Last Name:KOPPEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:555 E TACHEVAH DR
Mailing Address - Street 2:SUITE 2W-105
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5750
Mailing Address - Country:US
Mailing Address - Phone:760-327-1557
Mailing Address - Fax:760-327-1317
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:SUITE 2W-105
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5750
Practice Address - Country:US
Practice Address - Phone:760-327-1557
Practice Address - Fax:760-327-1317
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23686207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A236860Medicaid
CA00A236861Medicare PIN
CA00A236860Medicaid
CAZZZ03230ZMedicare ID - Type UnspecifiedGROUP NO.