Provider Demographics
NPI:1447264981
Name:COPEN, STEPHEN T (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:COPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 S REEVES DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3005
Mailing Address - Country:US
Mailing Address - Phone:310-274-2488
Mailing Address - Fax:310-273-0090
Practice Address - Street 1:8631 W 3RD ST # 1140E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-854-3390
Practice Address - Fax:310-854-3392
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79517207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G795170OtherBLUE SHIELD
CA00G795170Medicaid
CAG39496Medicare UPIN
CAG79517Medicare ID - Type Unspecified