Provider Demographics
NPI:1053390203
Name:KOPYEV, VICTOR Y (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:Y
Last Name:KOPYEV
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 1:1949 STATE ROUTE 59
Mailing Address - Street 2:STE 102
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-8124
Mailing Address - Country:US
Mailing Address - Phone:330-673-0505
Mailing Address - Fax:330-673-8708
Practice Address - Street 1:1949 STATE ROUTE 59
Practice Address - Street 2:STE 102
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-8124
Practice Address - Country:US
Practice Address - Phone:330-673-0505
Practice Address - Fax:330-673-8708
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100594OtherKAIZER PERMANENTE
9379301OtherMEDICARE PTAN GROUP
OH635OtherSUMMA
OHP1482767OtherOXFORD HEALTH PLAN
OHQ001339OtherHOMETOWN
4251121OtherMEDICARE PTAN INDIVIDUAL
OH110233939OtherUNITED HEALTH CARE
000000586847OtherANTHEM GROUP
000000586851OtherANTHEM INDIVIDUAL
OH2879532Medicaid