Provider Demographics
NPI:1912965047
Name:CLOPPER, MARVIN (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:CLOPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:2 ESSEX DR
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-532-2800
Practice Address - Fax:978-977-4492
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA26340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD25028OtherBLUE CROSS
MA70443OtherHARVARD PILGRIM
MA705889OtherTUFTS
MA0117481-001OtherCIGNA
MA3214510OtherAETNA
MA0016134OtherNEIGHBORHOOD HEALTH
MA2095963Medicaid
MA70443OtherHARVARD PILGRIM
MAD25028OtherBLUE CROSS