Provider Demographics
NPI:1396709556
Name:KOPF, RICHARD J (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:KOPF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7863
Mailing Address - Country:US
Mailing Address - Phone:203-794-1979
Mailing Address - Fax:203-794-1796
Practice Address - Street 1:132 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7863
Practice Address - Country:US
Practice Address - Phone:203-794-1979
Practice Address - Fax:203-794-1796
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000029363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970000874Medicare ID - Type Unspecified
CTP39410Medicare UPIN